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Biomedical subjects

J Rovira

Publications and source records attributed to J Rovira.

At least 19 recordsLinked to original sources
PubMed2003

[Is laparoscopic surgery the technique of choice in nephrectomy?].

Laparoscopic is performed in adults for the treatment of benign renal diseases. It is widely accepted that laparoscopic surgery has more advantages than open surgery in many procedures such as nephrectomy, but there is no further experience in this technique. In pediatric urology laparoscopy has become an accepted approach for varicocele, non palpable testis, bladder augmentation, adrenalectomy and urinary diversion. We report our experience with 25 laparoscopic nephrectomies in children.

Adolescent↗
PubMed2001

Beyond health gain: the range of health system benefits expressed by social groups in Mexico and Central America.

Current health reform proposals in most developing countries stress health gain as the chief evaluation criterion. Essential service packages are formulated using cost-effectiveness methods for the selection of interventions without sufficient regard for other factors that are significant for successful implementation and acceptance by the needy. This paper presents the results of research undertaken in Mexico and Central America to test the hypothesis that population groups view health gain as only one among several benefits derived from health systems. The goal at this stage was two-fold: (a) to identify through qualitative methods the range of benefits that are significant for a wide cross-section of social groups and (b) to classify such benefits in types amenable to be used in the development of instruments to measure the benefits intended and actually produced by health systems. Fourteen focus groups were undertaken in Costa Rica, El Salvador, Guatemala, Mexico and Nicaragua representing diverse age, gender, occupation and social conditions. Six major types of health system benefits were identified besides health gain: reassurance/uncertainty reduction, economic security, confidence in health system quality, financial benefits derived from the system, health care process utility and health system fairness. Benefits most often mentioned can be classed under health care process utility and confidence in system quality. They also have the most consensus across social groups. Other benefits mentioned have an affinity with social conditions. Human resource-derived utility stands out by its frequency in the range of benefits mentioned. Health systems and health sector reform proposals must emphasise those aspects of quality related to human resources to be in accord with population expectations.

Adolescent↗
PubMed2001

Immunocytochemical and ultrastructural characterization of endocrine cells in the larval stomach of the frog Rana temporaria tadpoles: a comparison with adult specimens.

According to immunostaining and ultrastructural patterns, Rana temporaria tadpole stomach displays a well-differentiated endocrine population comprising, at least, six cellular types: ECL, EC [serotonin], D [somatostatin] - all three of them abundant -, P [bombesin] - less numerous -, CCK-8 [cholecystokinin/gastrin] and A [glucagon/glicentin] - both very scarce. Larval endocrine cells are mainly located in the surface epithelium and show open or closed morphologies. Cellular diversity is similar in tadpoles and frogs, with the exception of immunoreactivity for gastrin-17, found in adults in numerous cells. Larval cells display mature ultrastructural traits, although with smaller secretory granules. The different distribution of endocrine cells, which in adults are preferentially located in the glands, probably refers to different functional requirements. However, the rich vascular plexus present in larval mucosa may be an efficient transport medium of surface hormones to-gastric targets. The enhancement in adults of endocrine population and correlative increase in hormonal secretion indicates a more active functional role, probably related to the shift from herbivorous to carnivorous habits. In summary, the tadpole gastric endocrine population, although not as numerous as that of adult frogs, displays histological traits that indicate a relevant (immunoreactive and ultrastructural properties, cellular diversity) and specific (surface location, relative abundance of open-type cells) role of local regulatory factors in amphibian larval gastric function.

Animals↗
PubMed2000

Characterisation of Micrococcaceae isolated from different varieties of chorizo.

A total of 426 strains of Micrococcaceae bacteria isolated from chorizo (a traditional Spanish fermented sausage) were identified. The chorizos were sampled from three regions of Castilla and León in Spain: Burgos, Segovia and Salamanca. Two factories were chosen in each region and the samples were taken at three stages of ripening. Staphylococcus xylosus was the most predominant species isolated (95%). Twelve strain types of S. xylosus were established according to their fermentation patterns, and two of them, S. xylosus type 2 and S. xylosus type 5, made up the majority of the strains of S. xylosus isolated (27 and 52%). Production of acetoin, nitrate reductase, urease activity, proteolytic and lipolytic activity were determined for all isolates. The percentage of strains of S. xylosus producing acetoin depends on the manufacturing location. In general, the proteolytic and lipolytic activities of the S. xylosus isolated from chorizo from Castilla and León were low and moderate; 97% of the strains showed nitrate reductase and urease activity. According to our results and to previous investigations, it seems that S. xylosus type 5, showing nitrate reductase and urease activity, low-moderate proteolytic and lipolytic activities and not producing acetoin would be suitable as a starter culture. Of the strains isolated in this study, 38% comply with these requirements.

Animals↗
PubMed2000

Characterization of pancreatic endocrine cells of the European common frog Rana temporaria.

To characterize the endocrine cell types of the pancreas of Rana temporaria, conventional staining, silver impregnation, and immunocytochemical methods for light and electron microscopy have been applied to paraffin, thin and semithin sections, many of them serial pairs. Quantitative data on the frequency and distribution (insular, extrainsular among the exocrine cells, or within the pancreatic ducts) of each endocrine cell type are also reported. Four distinct endocrine cell types have been identified: insulin (B) cells, which are also immunoreactive for [Met]enkephalin; glucagon/PP (A/PP) cells, also immunoreactive for GLP1; somatostatin (D) cells; and a fourth endocrine-like cell type (X cells) of unknown content and function. X cells display characteristic ultrastructure and tinctorial traits but are nonimmunoreactive for all of the 37 antisera tested. The presence of [Met]enkephalin in amphibian pancreatic endocrine cells is now reported for the first time. Almost half (44.9 +/- 7.9) of the total endocrine cell population lies outside the islets, mainly spread among the exocrine cells. Approximately 37.2 +/- 4.6% of the total endocrine cell population was immunoreactive for insulin, 48.8 +/- 6.9% was immunoreactive for glucagon/PP, and 14.0 +/- 4.9% was immunoreactive for somatostatin; 79.2 +/- 6.4% of glucagon/PP cells are found within the exocrine parenchyma, representing the majority (86.4 +/- 4.3%) of extrainsular endocrine component. On the contrary, most B cells (94.2 +/- 2.1%) are located within the islets; 30.8 +/- 12.9% of D cells are found outside the islets.

Animals↗
PubMed2000

[Recent developments in the economic evaluation of health].

BACKGROUND: The economic evaluation of health programmes and technologies is a booming discipline. A recent review estimated the volume of published studies in 1,800 per year, more than half of them being applied studies. MATERIAL AND METHODS: This article reviews the most relevant recent trends in the development of the discipline, which can be summarized as follows: a) cost-utility analysis has become a well established approach and cost-benefit analysis is growing very fast, although in absolute terms it still plays a minor role (many studies are presented as cost-consequence analyses, which means that health benefits are measured in different ways); b) there is an increasing relationship between economic evaluation and clinical research, which often forms the core of applied studies; c) there is an increasing concern for the issues related to the application of economic evaluation to decision-making; d) a related issue is the manifold proposal on methodological standards issued by different organizations and academic groups, with the aim of improving the comparability and transferability of the results, and e) finally, increasing attention is being paid to the knowledge, attitudes and actual use, of economic evaluation by decision-makers. CONCLUSIONS: To sum up, economic evaluation appears to be very dynamic in its theoretical aspects, but it is also concerned with its ultimate justification of being a useful tool for decision-makers.

Cost-Benefit Analysis↗
PubMed1999

[Costs of health care resources of ambulatory-care patients diagnosed with Alzheimer's disease in Spain].

BACKGROUND: The annual consumption and costs of the health care resources used by ambulatory Alzheimer's disease patients were estimated. Patients were classified according to the degree of severity of the disease using Folstein's Mini Mental State Examination scale. The sociodemographic characteristics of both patients and their careers were described. PATIENTS AND METHODS: Patients with an established diagnosis of Alzheimer's disease according to NINCDS/ADRDA criteria were included in the study. Information on the use of health and non-health care resources consumed during the last 12 months was recorded. The following scales were administered: MMSE, Global Deterioration Scale, Rapid Disability Rating Scale and Hachinski's scale modified by Rosen. Finally, the time dedicated by careers to look after the Alzheimer's disease patients was recorded. RESULTS: A total of 337 patients were considered to be valid for the analysis with an average of 72 (8.4) years and with an average duration of the disease of 48.3 (35.7) months. The average annual cost per patient was 3,194,664 ptas. The average cost per patient in the group with MMSE > 18 was 2,119,889 ptas; 2,723,159 ptas. in those with MMSE 12-18 and 3,676,707 ptas. in the MMSE < 12 group. CONCLUSIONS: In patients with Alzheimer's disease an increase in cost directly related to functional cognition state was observed. The most important cost component was that imputed to value time dedicated by principal career.

Aged↗
PubMed1999

Outcomes in peritoneal dialysis and haemodialysis--a comparative assessment of survival and quality of life.

Ever since the introduction of peritoneal dialysis (PD) as a therapy for managing patients with end-stage renal disease, there has been considerable debate about how it compares with outcomes on haemodialysis (HD) especially in terms of survival and quality of life. Whilst earlier results in the 1980s were certainly not comparable, data now emerging show that survival on PD is equivalent to that on HD. Recent registry data from the Canadian Organ Replacement Register show that survival of patients on PD is equivalent to that on HD and may well be better in the first few years of therapy. There have been numerous quality of life studies in patients on PD and HD. Health-related quality of life has been assessed using health profile measurements (both generic and disease-specific instruments) or preference-based measurements. The former approach has been used to analyse 14 different comparative studies. These studies suggest that patients on home HD and CAPD show better quality of life than patients on centre HD. Only a few studies found statistical differences between groups, and only in seven studies were results adjusted for patient differences. There is a need for longitudinal studies with more accurate information on health. Similar data are available for preference-based measurements and studies. Overall, the analysis suggests that PD and HD are equivalent therapies. On this basis, it is hard to explain the wide variation seen in the use of the two therapies.

Humans↗
PubMed1998

Comparative study of lactic acid bacteria house flora isolated in different varieties of 'chorizo'.

A total of 516 strains of lactic acid bacteria isolated from 'chorizo' (a Spanish dry fermented sausage) were identified. The 'chorizo' was from three zones of Castilla and León in Spain: Burgos, Segovia and Salamanca. Two factories were chosen in each zone and the samples were taken at three stages of ripening. L. sake was the most predominant species present (68.8%) followed by L. curvatus (16.47%) and Pediococcus sp. (8.52%). Different strains that do not belong to the above species were grouped as Lactobacillus sp. Group S1 comprising maltose and lactose negative L. sake was the main group present in all factories except in a factory in Segovia where group S3 comprising lactose positive L. sake and pediococci were the predominant ones. Group S1 increased during the ripening process in all six factories and it dominated in the ripened 'chorizo' except in the mentioned factory in Segovia. In general strains of L. sake and L. curvatus which fermented maltose but not lactose were more dominant at the beginning and in the middle of the process, whereas, L. sake and L. curvatus which could ferment lactose, or lactose and maltose occurred in higher numbers in semi-ripened 'chorizo' and in the final product. This indicates that strains which could ferment lactose were more competitive towards the end of the process. Strains from group S1 were the microorganisms responsible for the pH drop in most of the factories, giving the correct texture. As a result it would appear that a strain from this group would be most suitable for use as starter culture.

Animals↗
PubMed1998

Relationship between epithelial and connective tissues in the stomach of the frog Rana temporaria during metamorphosis: an ultrastructural study.

In the course of metamorphosis of the stomach of Rana temporaria tadpoles there is a marked increase in the amount of active mesenchymal fibroblasts and extracellular matrix underlying the regenerating gastric epithelium. At the onset of metamorphosis, a thick PAS-positive basement membrane is developed around the epithelial component of the mucosa, formed by the apical, degenerating larval epithelium and the basal, regenerative epithelial cords. Under the electron microscope, a folded basement membrane is usually revealed under the apical degenerating epithelium while a compact basement membrane (up to 1-2 microns thick), forming both patches and more extensive areas, is frequently seen around the regenerative glandular cords. Cytoplasmic processes, extending from both the epithelial and mesenchymal fibroblastic cells, cross the basement membrane and make physical contact between the two cellular types. At mid-metamorphosis areas of thick PAS-positive basement membrane are still observed around the differentiating glandular outlines, before disappearing completely at late metamorphosis. The probable involvement of intertissue interactions between epithelium and connective elements in the morphogenesis, proliferation and differentiation of secondary, definitive frog stomach is discussed. Early contacts between epithelium and phagocytes, probably related to the invasion of epithelium by the phagocytic cells, have also been observed.

Animals↗
PubMed1998

Should antibacterials be deregulated?

Deregulation of antibacterials is a recurrent topic in the debate on pharmaceutical policy. This article focuses on one aspect of pharmaceutical regulation, namely the requirement of a medical prescription for purchasing antibacterials. However, a strategy of deregulation should not only concern the switch from prescription-only status to nonprescription status for a given drug, but should consider some complementary measures to minimise potentially harmful effects on health and costs. Risk-benefit and economic evaluations, which are possible approaches to assess the convenience of antibacterial deregulation, force the empirical evidence, the assumptions, as well as the value judgements on which the options are evaluated, to be made explicit. We outline the basic traits of an economic-evaluation approach to assess the issues related to the public interest and the feasibility of a deregulation policy. However, the answer cannot be a generic one, but should address the question for each particular country, and for each antibacterial and indication. Given the limitations of existing evidence on that issue, a tentative research agenda is also proposed.

Anti-Bacterial Agents↗
PubMed1998

Parallel imports of pharmaceuticals in the European Union.

Parallel importing has existed on a small scale in Europe for many years and has been upheld by the European Court of Justice as consistent with standard principles of free trade. However, the potential impact of parallel trade has increased significantly with the launch of the European Medicines Evaluation Agency in 1995, the accession to the European Union (EU) of countries with traditionally low prices, such as Spain, and the possible accession of Eastern European countries. This article examines the current state of parallel trade in medicines in the EU (different modalities and the medicines affected), analyses some policy implications associated with parallel trade (who gains and who loses) and explores the effects of several policy scenarios affecting parallel trade. The main conclusion is that a single European price is probably not the best solution from a European welfare point of view. A solution to the present situation could be achieved by separating the market price (at which any agent is allowed to buy a product either for consumption or for resale) and the price actually paid by a final consumer. Discounts and reference pricing may present two of the most feasible options.

Drug Costs↗
PubMed1997

[Costs of known diabetes mellitus in Spain].

BACKGROUND: Diabetes mellitus is an important cause of mortality and morbidity in western nations with high costs for both patients and health care systems. MATERIAL AND METHODS: Based on the latest epidemiological studies and in combination with Spanish demographic data the direct health care costs of known diabetes mellitus were estimated for the following areas: hospitalisation directly due to the disease, hospitalisation due to certain chronic complications such as acute myocardial infarction, amputations and renal disease (dialysis and transplant), outpatient visits, consumption of anti-diabetic medication, self-control, analyses, additional explorations and camps for diabetic children. RESULTS: In 1994, the total direct costs of diabetes mellitus in Spain were estimated to be more than 90,000 millions pesetas in a population of more than 1,400,000 known diabetic persons. This implies an average annual costs of approximately 63,000 pesetas per patient. If this cost is divided into categories, hospitalisation represents approximately 58% of the global cost, outpatient visits 14%, antidiabetic drugs 13%, self-control 4.7%, analyses 10% and camps a mere 0.04%. CONCLUSIONS: The most important component of the costs of diabetes mellitus in Spain in 1994 was hospitalisation due to the disease itself and its chronic complications which would seem to logically imply that resources ought to be targeted at reducing or postponing the development of such complications.

Adult↗
PubMed1997

A simulation model of the cost of the incidence of IDDM in Spain.

This study estimates the direct health care costs of the incidence of insulin-dependent diabetes mellitus (IDDM) in Spain. A discrete event simulation model was developed to approximate the natural history of a cohort of newly diagnosed patients in a given year and used to calculate the average costs which would accumulate during the lifetime of the group of patients. The model takes into account both the underlying costs of control and maintenance of the disease plus the additional costs of long-term complications that are likely to develop as the disease progresses. The model is based on national and international epidemiological and demographic information combined with local cost data. The number of newly diagnosed cases of IDDM each year, based on Spanish epidemiological data, was calculated to be approximately 1791 cases in 1994. The baseline results from the model indicate that the average life expectancy of an IDDM patient is approximately 59.6 years with an average lifetime cost of 12.7 million pesetas per individual (1994 undiscounted values), 5.1 million pesetas per individual when discounted at a rate of 6% and 8060 million pesetas for the entire newly diagnosed cohort discounted at a rate of 6%. Sensitivity analysis was undertaken in order to observe the effect on the result of changes in the values of key variables.

Adolescent↗
PubMed1997

Differences in the methodology and data of economic evaluations of a health programme. The case of hepatitis B vaccination programmes in Spain.

Economic evaluations of hepatitis B vaccination programmes in Spain or particular regions of Spain were identified and analysed, and their methodologies and data were compared. The results revealed important differences in methodology and the way in which different parameters, such as duration of immunity, costs and sources of cost data, were defined and measured. Some of these variations could be justified by the need to adapt studies to specific contexts, while others appeared arbitrary. Although it is understandable that there should be a substantial amount of heterogeneity between studies, greater efforts need to be made to reduce unnecessary variations in the way in which different parameters are measured. Increasing standardisation in methodology, which nevertheless takes into account inevitable variations due to changing circumstances and perspectives, will help to make economic evaluation a more attractive proposition for decision makers.

Delivery of Health Care↗
PubMed1997

An immunocytochemical and ultrastructural study of the larval anterior intestine of the frog Rana temporaria, with especial reference to endocrine cells.

Endocrine cells of the larval intestine of Rana temporaria tadpoles have been identified by argyrophilic, immunocytochemical and electron-microscopical techniques. Scarce endocrine cells have been found in both the short non-absorptive zone immediately following the stomach, and in the rest of the anterior intestine. Endocrine cells are frequently seen to extend a cytoplasmic process towards the lumen. Immunoreactivity for serotonin, somatostatin, bombesin and cholecystokinin-8 has been detected. According to the ultrastructural traits of the endocrine granules, three larval intestinal endocrine populations have been differentiated.

Animals↗