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Healthcare workers (HCWs) not fulfilling the coronavirus disease 2019 (COVID-19) case definition underwent severe acute respiratory coronavirus virus 2 (SARS-CoV-2) screening. Risk of exposure, adherence to personal protective equipment (PPE), and symptoms were assessed. In total, 2,000 HCWs were screened: 5.5% were positive for SARS-CoV-2 by polymerase chain reaction (PCR). There were no differences in PPE use between SARS-CoV-2–positive and –negative HCWs (adherence, >90%). Nursing and kitchen staff were independently associated with positive SARS-CoV-2 results.
The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.
The Colombian Constitution of 1991 shaped the development of the social sector in Colombia, particularly in the provision of education and health. The new Constitution declared Colombia a “social rights state” and established education as a right and a public service with a social purpose. At the same time, it declared decentralization as a fundamental principle. These two features led to a series of reforms during the 1990s in terms of the institutional and organizational arrangements for the provision of education services. Within this context, a new set of reforms in education took place. One of the most important was the teachers’ reform, an area that continues to have repercussions even 25 years later.
This chapter looks at teacher policy to illustrate the practice of policy analysis in education policy in Colombia at the national level after the 1990s reforms. In particular, we use reform in policies regarding public school teachers as a case to analyse the process of policy formulation and implementation in the education sector in Colombia. We focus on teacher policy for two main reasons. First, it has marked the education sector over the past 20 years, defining several issues that have a direct impact on the quality of primary and secondary education (such as whether or not teachers are required to have professional degree, or whether or not teachers who do not perform well should stay in schools). Second, teacher policy involves several stakeholders and decisions in several domains, allowing illustrating the complexity of policy analysis in the education sector. The chapter has four main objectives: to explain how education policy is constructed; to document the main criteria used in education policy design; to identify the main stakeholders involved; and to assess the extent to which technical and political factors weigh in the policy construction process.
Teacher policy refers to policies governing the hiring, training (pre-service and in-service), compensation and evaluation of teachers in the public sector. Specifically, we focus on six key dimensions: pre-service teacher training; selection and hiring of teachers; retention and promotion; performance evaluation; inservice training; and salaries. These dimensions follow the literature on education policy (García et al, 2014).
OBJECTIVES/GOALS: To determine the relationship among serum concentration of tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) and mortality in community-acquired pneumonia (CAP) patients. METHODS/STUDY POPULATION: This is a multicenter 2-year cohort study in Spain, designed to better understand the role of sTWEAK concentrations in CAP patients. CAP patients were prospectively enrolled in two University hospitals and sTWEAK was measured within the first 24 hours of ICU admission. Samples were collected and stored for laboratory analyses. To detect sTWEAK in human samples, we used a commercially available ELISA kit following manufacturer’s instructions. Demographic patients’ characteristics and ICU mortality were prospectively collected. Descriptive statistics and logistical regressions were used to assess the proposed aims. RESULTS/ANTICIPATED RESULTS: A total of forty-three patients were included in the study (10 healthy users, 10 uninfected controls and 23 CAP patients). In comparison to healthy volunteers, patients admitted to the hospital (both, infected and non-infected) had lower level of sTWEAK. During hospital admission, 7 (17%) patients died. Patients whom died during ICU stay due to CAP, had significantly lower levels of sTWEAK when comparing with patients whom survived (Median [IQR]; 509.35 [357.49, 953.92] Vs 1103.03 [716.93, 1663.16]; p = 0.015). In contrast, patients that developed shock did not have different concentrations of sTWEAK (Median [IQR]; 1008.04 [531.87, 1390.80] Vs 1062.29 [575.24, 1598.83], p = 0.84). DISCUSSION/SIGNIFICANCE OF IMPACT: Community-acquired pneumonia (CAP) is the first cause of death in underdeveloped countries. CAP is a pulmonary infection that creates a proinflammatory environment not just locally but also systemically, secondary to upregulation of molecular cascades with a wide variety of proteins being released perpetuating this inflammation and tissue damage. Several of these molecules have been described and linked to a greater risk of inhospital complications, longer length of hospital stay and mortality. TNF-like weak inducer of apoptosis (TWEAK) is a member of the TNF-alpha superfamily, involved in immune response, cell growth, angiogenesis, NF-kB activation and apoptosis induction in tumor cells. It is known that serum-TWEAK plays a role in inflammatory processes, however, its behavior is unknown in patients with CAP. Therefore, this study aims to identify whether there is a relationship between serum concentration of TWEAK and prognosis in CAP patients. To our knowledge, this is the first study to shown that concentration of sTWEAK within the first 24 hours of ICU admission is lower in patients with CAP. Moreover, patients whom died during ICU admission due to CAP, have lower sTWEAK levels. This biomarker may identify patients at higher risk of dying due to CAP and may represent severe CAP. However, further studies are needed to confirm these findings.
Conditional cash transfer (CCT) programs have become an important component of social assistance in developing countries. CCTs, as well as other cash subsidies, have been criticized for allegedly crowding out private transfers. Whether social programs crowd out private transfers is an important question with worrisome implications, as private support represents an important fraction of households’ income and works as a risk sharing mechanism in developing countries. Furthermore, empirical evidence on the effect of public transfers on private transfers is mixed. This paper contributes to the literature by using a unique dataset from the quasi-experimental evaluation of a CCT in Colombia and an empirical strategy that allows us to correct for pre-existing differences between treated and control groups. Our results suggest that the public transfer did not crowd out private transfers, neither in the short-run nor in the middle-run. Instead, it increased the probability of receiving support in cash, in kind, and in non-paid labor from different private sources by approximately 10 percentage points. Moreover, we find that the monetary value of private transfers increased by 32-38% for treated households.
Neuroanatomical abnormalities in first-episode psychosis (FEP) tend to be subtle and widespread. The vast majority of previous studies have used small samples, and therefore may have been underpowered. In addition, most studies have examined participants at a single research site, and therefore the results may be specific to the local sample investigated. Consequently, the findings reported in the existing literature are highly heterogeneous. This study aimed to overcome these issues by testing for neuroanatomical abnormalities in individuals with FEP that are expressed consistently across several independent samples.
Structural Magnetic Resonance Imaging data were acquired from a total of 572 FEP and 502 age and gender comparable healthy controls at five sites. Voxel-based morphometry was used to investigate differences in grey matter volume (GMV) between the two groups. Statistical inferences were made at p < 0.05 after family-wise error correction for multiple comparisons.
FEP showed a widespread pattern of decreased GMV in fronto-temporal, insular and occipital regions bilaterally; these decreases were not dependent on anti-psychotic medication. The region with the most pronounced decrease – gyrus rectus – was negatively correlated with the severity of positive and negative symptoms.
This study identified a consistent pattern of fronto-temporal, insular and occipital abnormalities in five independent FEP samples; furthermore, the extent of these alterations is dependent on the severity of symptoms and duration of illness. This provides evidence for reliable neuroanatomical alternations in FEP, expressed above and beyond site-related differences in anti-psychotic medication, scanning parameters and recruitment criteria.
Cognitive behavioural models of hypochondriasis assume that dysfunctional illness-related beliefs are involved in the genesis and maintenance of the disorder. The role that other more general dysfunctional beliefs about thoughts play in this disorder has also been highlighted. Internal triggers such as illness-related intrusive thoughts could activate these beliefs.
The present paper examines whether general dysfunctional beliefs about distressing thoughts, such as intolerance of uncertainty, over-estimation of threat, and thought-action fusion-likelihood, mediate between illness-related intrusive thoughts and health anxiety symptoms.
A group of participants composed of individuals with hypochondriasis (n = 31; 51.5% women; mean age = 32.74 years, SD = 9.96) and community individuals (n = 219; 54.3% women; mean age = 39.56 years, SD = 15.20) completed a series of questionnaires to assess illness-related intrusive thoughts (INPIE), dysfunctional beliefs about thoughts (OBSI-R), and health anxiety symptoms (SHAI).
Results from a multiple parallel mediation analysis indicate that over-estimation of threat partially mediated the relationship between illness-related intrusive thoughts and health anxiety symptoms.
The results support the importance of the tendency to over-estimate the threat in the relationship between intrusive thoughts related to illness contents and health anxiety. Conceptual and clinical implications of these results are discussed.
Silene ciliata (Caryophyllaceae) is a key species to test evolutionary hypotheses in a global warming context. The recent advances in Next Generation Sequencing technologies can help in providing clues about climate-mediated local adaptation. In the present study, we analysed the full transcriptome of six individuals of S. ciliata from Central Spain, by aligning it with the transcriptome of S. latifolia. We aimed (a) to identify Single Nucleotide Polymorphisms (SNPs) in the transcriptome of the species, (b) to describe the biological function of the polymorphic genes expressed and (c) to identify loci that may be involved in local adaptation processes at optimal and marginal populations of the species. We identified a total of 147,118 SNPs distributed throughout 12,688 sequences. The number of polymorphic sequences annotated was 8023. One hundred thirty sequences containing polymorphisms strongly associated with optimal and marginal conditions were selected. Gene ontology searches were successful for 118, and many of these were related to responses to stress (n = 19) and abiotic stimulus (n = 16). Genomic data generated provide a starting point for further research on the identification of candidate genes related to local adaptation and other processes in the species.
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.
A study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC.
Primary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach.
A total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948].
These data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms.
The aim of this study was to compare the main proposed models for the Purpose-In-Life Test, a scale for assessing meaning in life, in 229 Spanish patients with mental disorders (195 females and 34 males, aged 13–68, M = 34.43, SD = 12.19). Confirmatory factor-analytic procedures showed that the original model of the Purpose-In-Life Test, a 20-item unidimensional scale, obtained a better fit than the other analyzed models, SBχ2(df) = 326.27(170), SBχ2/df = 1.92, TLI = .93, CFI = .94, IFI = .94, RMSEA = .063 (90% CI [.053, .074]), CAIC = –767.46, as well as a high internal consistency, (α = .90). The main conclusion is that the original version of the Purpose-In-Life shows a robust construct validity in a clinical population. However, authors recommend an in-depth psychometric analysis of the Purpose-In-Life Test among clinical population. Likewise, the importance of assessing meaning in life in order to enhance psychotherapeutic treatment is noted.
There is an increasing interest in divesting activities, giving rise to several initiatives both academic and governmental to identify and address one of the problems of health systems. In 2013 the Spanish Atlas of Variability in Clinical Practice (VPM) in collaboration with the Spanish Network of Health Technology Assessment (HTA) Agencies started a project with the purpose of providing elements to support a national strategy aimed at minimizing the use of doubtful procedures in the Spanish National Health System (1).
The identification, selection and definition of low added value procedures and the determination of the most cost-effective alternatives were carried out jointly between the AtlasVPM group and the HTA agencies of Andalusia (AETSA), Catalonia (AQUAS), Galicia (Avalia-t), Basque Country (Osteba), Madrid (UETS) and Aragon (IACS). The process consisted of the following phases: (i) Literature review; (ii) Preliminary list of procedures of dubious value; (iii) Analysis of feasibility and construction of the indicators (variability); and (iv) Empirical validation of the defined indicators. Different lists and sources of evidence were used to identify the procedures and evidence that support their low-value.
The synthesis of the evidence gave rise to an initial list of fifty-nine procedures of doubtful value that could be classified as: obsolete or outdated procedures in comparison to more effective / cost-effective alternatives (n = 31), procedures of doubtful value when used outside their main indication (n = 17) and procedures for which the evidence around effectiveness was still insufficient (n = 11). With the advice of clinical experts and coders, the original list was reduced to seventeen procedures and after some adjustments to thirteen.
Identifying procedures of low-added value is a complex task and is context dependent. Literature could be useful to identify a preliminary list but the analysis of the clinical practice, its variability and reasons that justify it are required to determine which procedures are good candidates for disinvestment.
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.
The aim of this study was to compare serum lipid profiles and ovarian gene expression between aged and younger female mice fed a control or a high-fat diet for 2 months. For this 16 female mice (C57BL/6) of 4 months (Young, n = 8) or 13 months (Old, n = 8) of age were used. The females were divided into four groups: (i) young females fed a normal diet; (ii) young females fed a high-fat diet; (iii) old females fed a normal diet; and (iv) old females fed a high-fat diet. Food intake was reduced (P < 0.05) in mice fed with a high-fat (2.9 ± 0.1 g) diet in comparison with control mice (3.9 ± 0.1 g). Body weight was higher for old females on the high-fat diet (35.1 ± 0.3 g) than for young females on the same diet (23.3 ± 0.4 g; P < 0.05). PON1 activity was lower in the high-fat than control diet group (114.3 ± 5.8 vs. 78.1 ± 6.0 kU/L, respectively) and was higher in older than younger females (85.9 ± 6.4 vs. 106.5 ± 5.3; P < 0.05, respectively). Females fed a high-fat diet had lower expression of Igf1 mRNA (P = 0.04). There was an interaction between age and diet for the expression of Gdf9 and Survivin, with lower expression in older females in both diets and young females that received the high-fat diet (P < 0.05). Concluding, the high-fat diet reduced the expression of ovarian Igf1 mRNA, and Gdf9 and Survivin mRNA in younger females, which can indicate lower fertility rates. High-density lipoprotein concentration and PON1 activity were higher in aged female mice.
Objectives: Behavioral variant frontotemporal dementia (bvFTD) is characterized by early atrophy in the frontotemporoinsular regions. These regions overlap with networks that are engaged in social cognition-executive functions, two hallmarks deficits of bvFTD. We examine (i) whether Network Centrality (a graph theory metric that measures how important a node is in a brain network) in the frontotemporoinsular network is disrupted in bvFTD, and (ii) the level of involvement of this network in social-executive performance. Methods: Patients with probable bvFTD, healthy controls, and frontoinsular stroke patients underwent functional MRI resting-state recordings and completed social-executive behavioral measures. Results: Relative to the controls and the stroke group, the bvFTD patients presented decreased Network Centrality. In addition, this measure was associated with social cognition and executive functions. To test the specificity of these results for the Network Centrality of the frontotemporoinsular network, we assessed the main areas from six resting-state networks. No group differences or behavioral associations were found in these networks. Finally, Network Centrality and behavior distinguished bvFTD patients from the other groups with a high classification rate. Conclusions: bvFTD selectively affects Network Centrality in the frontotemporoinsular network, which is associated with high-level social and executive profile. (JINS, 2016, 22, 250–262)
Synthetic superabsorbent polymers (SAPs) are used in concrete for various applications such as internal curing and frost resistance. However, the addition of these SAPs may lead to a significant decrease in mortar strength, especially when high amounts of SAP are necessary. This is the case for example when self-sealing and -healing of cracks is strived at. In order to overcome this bottleneck, the present work focuses on the application of biopolymers as SAPs. The work especially aims to evaluate the potential of both sodium alginate (NaAlg) as well as physically cross-linked calcium alginate (CaAlg) as SAPs to establish a sustainable approach towards self-sealing and -healing concrete without impairing mechanical strength. First, the swelling properties in both demineralized water and cement filtrate solution are tested. Subsequently, the mechanical properties of mortar mixtures in the absence and the presence of SAPs are compared by performing flexural and compressive tests. The alginates show a swelling capacity up to 72 times their own weight in aqueous solutions. Interestingly, they lead to a minor reduction in compression strength (up to 15% upon addition of 1m% SAP). These biopolymers show high potential for enabling concrete repair, more specifically, for the self-sealing and -healing of cracks without impairing the strength.
In this work it was conducted a pre heat treatment of a number of samples of alumina with organic binder in order to remove most of the organic phase. The treatment showed no effect on the physical properties of test specimens; green bodies remained stable during sintering process. Preheating at 100 °C for 4 h followed by heating at 300 °C for 4 h were the most favorable conditions to avoid formation of defects in the sintered pieces.
In this paper we obtain a sharp height estimate concerning compact hypersurfaces immersed into warped product spaces with some constant higher-order mean curvature and whose boundary is contained in a slice. We apply these results to draw topological conclusions at the end of the paper.