Determinants of citizens' choice between public and private hospitals.

OBJECTIVE: This study assesses what factors determine citizens' preferences for a public or private hospital (assuming the choice is free of charge) according to the severity of the disease. MATERIAL AND METHOD: A web-based discrete choice experiment was carried out with 1777 individuals distinguishing between a control group (posed with a simple choice for each health condition) and added information for respondents of the treatment groups (distance, waiting time, advice from the family doctor, and recommendations from the social context). The relevance of these factors in relation to the severity of one's illness is investigated. The outcome variable is the choice of a public versus a private hospital for the treatment of a health issue of a different severity. RESULTS: The severity of the health issue has a moderator effect on the additional information for the treatment groups. Waiting time has a direct positive impact on the patient's preferred choice for a private hospital both for severe and non-severe health issues. Distance to the hospital and the family doctor's recommendation positively impact the preferred choice for a private hospital for non-severe health issues but not for severe health issues. Covariates like gender and age are not relevant in explaining the effects of the treatments, and educational level has a positive impact on one of the treatments: advice from the patient's environment. Satisfaction with public hospitals has a positive impact on all treatments. CONCLUSIONS: Results indicate that waiting time is a key factor in choosing a private hospital against the majority-stated preference for a public hospital.

Evaluación de la reproducción inducida de nicuro Pimelodus blochii (Telostei: Pimelodidae) utilizando diferentes inductores hormonales / Evaluation of induced breeding of Pimelodus blochii nicuro (telostei, pimelodidae) using different inducing hormone

Objetivo. Evaluar el efecto de dos inductores hormonales en la reproducción inducida de nicuro Pimelodus blochii. Materiales y métodos. Para los procesos experimentales fueron utilizados adultos sexualmente maduros, sometidos a tres tratamientos aplicados vía intramuscular, en dosis única de 0.25 mL/kg Ovaprim® (OVAP) (T1), 0.5 mL/kg de OVAP (T2) y 6.25 mg/kg de Extracto de Hipófisis de Carpa (EHC) (T3), para este último tratamiento la inyección fue dividida en 20 y 80%, con un intervalo de 12 h entre aplicaciones. Previo a la extracción de los gametos, los animales fueron tranquilizados por inmersión en una solución de Metanosulfonato de Tricaina (90 mg/L). El desempeño reproductivo fue evaluado mediante el índice de ovulación (hembras ovuladas/hembras tratadas), fecundidad absoluta (Fa) (ovocitos/hembra), fecundidad relativa (Fr) en función del número de ovocitos desovados por gramo de peso. La fecundación se realizó en seco y seis horas post-fecundación (HPF) se determinó la tasa de fertilidad. Resultados. La ovulación (ºh) para el T1 fue a las 297.1±30.0, T2 294.6±32.9 y T3 247.3±13.1 ºh. En todos los tratamientos se obtuvieron hembras ovuladas, donde los mayores índices de ovulación fueron obtenidos con Ovaprim® (T1 y T2) con 36.4 y 50%, respectivamente. Las tasas de fecundación obtenidas fueron mayores a un 50%, para el tratamiento 1 y 2, con valores de 74.5 y 32.7%, respectivamente. Conclusiones. El uso de inductores hormonales puede ser efectivo para garantizar la reproducción inducida del nicuro, en dosis única de 0.25 y 0.5 mL/kg de Ovaprim®.

Objective. Evaluate the effect of two hormonal inducers in induced breeding of nicuro Pimelodus blochii. Materials and methods. The experimental process used sexually mature adults exposed to three intramuscular treatments, a single dose of 0.25 mL/g Ovaprim® (OVAP) (T1), 0.5 mL/kg of OVAP (T2) and 6.25 mg/kg of pituitary carp extract (EPC) (T3), for the latter treatment the injection was divided into 20 and 80%, with an interval of 12 hours between applications. Prior to the removal of gametes, the animals were tranquilized by immersion in a Tricaine Methanesulfonate (90 mg/L) solution. Reproductive performance was evaluated using ovulation rates (females ovulated/treated females), fertility (Fa) (eggs/female), relative fertility (Fr) depending on the number of eggs spawned per gram of weight. The dry method of fertilization was used and the fertility rate was determined six hours post-fertilization (HPF). Results. The Ovulation (ºh) was: for T1 297.1±30.0, T2 294.6±32.9 and T3 247.3±13.1ºh. Ovulated females were obtained in all treatments, where the highest rates of ovulation were obtained with Ovaprim ® (T1 and T2) with 36.4 and 50% respectively. Fertilization rates were higher than 50% for treatments 1 and 2, with values of 74.5 and 32.7% respectively. Conclusions. The use of hormonal inducers may be effective to ensure nicuro induced reproduction with a single dose of 0.25 and 0.5 mL/kg Ovaprim®.

[Pharmacoeconomic assessment of daptomycin as first-line therapy for bacteraemia and complicated skin and skin structure infections caused by gram-positive pathogens in Spain]. / Evaluación farmacoeconómica de daptomicina como terapia de primera línea en el tratamiento de bacteriemia e infecciones complicadas de piel y tejidos blandos causadas por microorganismos grampositivos en España.

OBJECTIVE: To assess the efficiency of daptomycin as firstline therapy (D) versus daptomycin as salvage therapy after vancomycin (V→D ) or linezolid (L→D) failure in gram-positive bacteraemia and complicated skin and skin-structure infections (cSSTIs). METHODS: Cost-effectiveness analysis of 161 bacteraemia and 84 cSSTIs patients comparing the above mentioned therapeutic alternatives was performed using the data from 27 Spanish hospitals involved in the EUCORE study. Direct medical costs were considered. Patients were observed from the first antibiotic dose for infection until either the end of daptomycin therapy or exitus. A multivariate Monte Carlo probabilistic sensitivity analysis was applied for costs (lognormal distribution) and effectiveness (normal distribution). RESULTS: In terms of effectiveness there were no statistical differences between groups but referring total costs per patient, there were significant differences. Sensitivity analysis confirmed that D dominates over L→D between 44.2%-62.1% of simulations in bacteraemia and between 48.2%-67.5% in cSSTIs. In comparison to V→D, D dominance was detected in 29.2%-33.2% of simulations in bacteraemia and between 48.2%-59.3% in cSSTIs. CONCLUSIONS: Daptomycin as first-line therapy dominates over daptomycin as salvage therapy after linezolid failure both in bacteraemia and cSSTIs. Comparing daptomycin as first-line therapy with its use after vancomycin failure, in cSSTIs the former is dominant. In bacteremia daptomycin as first line therapy is as effective as daptomycin as salvage therapy after vancomycin failure and implies lower costs.

Structural basis for the substrate specificity of bone morphogenetic protein 1/tolloid-like metalloproteases.

Procollagen C-peptidase, also known as bone morphogenetic protein 1 (BMP-1), is a multidomain, zinc endopeptidase of the astacin M12A family. BMP-1 is the prototype of a small group of proteases that have key roles in extracellular matrix formation and morphogenesis. BMP-1, its splice form mTLD, and the related proteases TLL-1 and TLL-2 are considered as promising drug targets for the treatment of excessive fibrosis and muscle wasting. We report here the crystal structures of the protease domains of human BMP-1 and the closely related Tolloid-like protease 1 (TLL-1). The crystal structures reveal an unexpected conformation of a cysteine-rich loop within the active site, and suggest that a flap movement is required in order to allow substrate binding. On the basis of these substantial differences between the BMP-1 and astacin active sites, a structural basis for their differing substrate specificities is proposed.

A novel type of bifunctional inhibitor directed against proteolytic activity and receptor/ligand interaction. Cystatin with a urokinase receptor binding site.

Cancer invasion and metastasis is a process requiring a coordinated series of (anti-)adhesive, migratory, and pericellular proteolytic events involving various proteases such as urokinase-type plasminogen activator (uPA)/plasmin, cathepsins B and L, and matrix metalloproteases. Novel types of double-headed inhibitors directed to different tumor-associated proteolytic systems were generated by substitution of a loop in chicken cystatin, which is nonessential for cysteine protease inhibition, with uPA-derived peptides covering the human uPA receptor binding sequence uPA-(19-31). The inhibition constants of these hybrids toward cysteine proteases are similar to those of wild-type cystatin (K(i), papain (pm), 1.9-2.4; K(i), cathepsin B (nm), 1.0-1.7; K(i), cathepsin L (pm), 0.12-0.61). FACS analyses revealed that the hybrids compete for binding of uPA to the cell surface-associated uPA receptor (uPAR) expressed on human U937 cells. The simultaneous interaction of the hybrid molecules with papain and uPAR was analyzed by surface plasmon resonance. The measured K(D) value of a papain-bound cystatin variant harboring the uPAR binding sequence of uPA (chCys-uPA-(19-31)) and soluble uPAR was 17 nm (K(D) value for uPA/uPAR interaction, 5 nm). These results indicate that cystatins with a uPAR binding site are efficient inhibitors of cysteine proteases and uPA/uPAR interaction at the same time. Therefore, these compact and small bifunctional inhibitors may represent promising agents for the therapy of solid tumors.