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72-655: Article 46 of the Ley General de Sanidad establishes the fundamental characteristics of the SNS: Public intervention in collective health problems has always been of interest to governments and societies, especially in the control of epidemics through the establishment of naval quarantines , the closing of city walls and prohibitions on travel in times of plague , but also in terms of hygienic and palliative measures. Al-Andalus — Muslim -ruled medieval Spain—was distinguished by its level of medical knowledge relative to

144-429: A common source exposure or an environmental vector may spread a zoonotic diseases agent. Preparations for an epidemic include having a disease surveillance system; the ability to quickly dispatch emergency workers, especially local-based emergency workers; and a legitimate way to guarantee the safety and health of health workers. Effective preparations for a response to a pandemic are multi-layered. The first layer

216-446: A decentralized system, it attempts to establish certain basic, common safeguards throughout the country. This law attempts to establish collaboration of public health authorities with respect to benefits provided, pharmacy, health professionals, research, health information systems, and the overall quality of the health system. Toward these ends, the law created or empowered several specialized organs and agencies, all of which are open to

288-449: A disease epidemic. By the early 17th century, the terms endemic and epidemic referred to contrasting conditions of population-level disease, with the endemic condition a " common sicknesse " and the epidemic " hapning in some region, or countrey, at a certaine time, ....... producing in all sorts of people, one and the same kind of sicknesse ". The term "epidemic" is often applied to diseases in non-human animals, although " epizootic "

360-600: A fast-spreading pandemic may easily exceed and overwhelm existing health-care resources. Consequently, early and aggressive mitigation efforts, aimed at the so-called "epidemic curve flattening" need to be taken. Such measures usually consist on non-pharmacological interventions such as social/physical distancing, aggressive contact tracing, "stay-at-home" orders, as well as appropriate personal protective equipment (i.e., masks, gloves, and other physical barriers to spread). Moreover, India has taken significant strides in its efforts to prepare for future respiratory pandemics through

432-468: A health care system sufficient for the needs of their respective jurisdictions. Article 149.1.16 or the Constitution, a further basis for the present law, establishes substantive principles and criteria that allow general and common characteristics to be consistent throughout the new system, providing a common basis for health services throughout Spanish territory. The administrative device set up by

504-668: A la Dependencia y a la Discapacidad ). The objective of this reorganization is to reinforce the role of the single ministry as the instrument of cohesion for the National Health System (SNS), adding to the portfolio of the Secretary General of Health purview in matters of the quality of the SNS by adding to it the Agency of Quality of the National Health System ( Agencia de Calidad del Sistema Nacional de Salud ) and

576-445: A period of time; an evolutionary change which increases survival time will result in increased virulence. Another possibility, although rare, is that a pathogen may adapt to take advantage of a new mode of transmission Seasonal diseases arise due to the change in the environmental conditions, especially such as humidity and temperature, during different seasons. Many diseases display seasonality , This may be due to one or more of

648-518: A plenary body, by delegated committees, through technical commissions, and through work groups. It meets as a plenary body at the initiative of its president or at the initiative of one-third of its members; plenary meetings occur at least four times a year. To some extent, this is a formality: resolutions from CISNS commissions are typically adopted by consensus. Cooperation agreements to conduct joint health actions are formalized in CISNS agreements. Under

720-740: A population between 5,000 and 20,000 inhabitants. The Basic Health Zone is served by a single general hospital and specialists' center. Article 12 of the Law of Cohesion establishes the concept of "primary care," the basic level of patient care that guarantees the comprehensiveness and continuity of care throughout the patient's life, acting as manager and coordinator of cases and regulator of issues. Primary care includes health promotion, health education, prevention of illness, health care, maintenance and recuperation of health, as well as physical rehabilitation and social work. Primary health care includes service provided either on-demand, scheduled, or urgently, both in

792-478: A right of all citizens, and Title VIII, which foresaw that purview over matters of health would devolve to the autonomous communities . The General Health Law of 1986 ( Ley 14/1986 General de Sanidad ) was formulated on two bases. First, it carries out a mandate of the Spanish Constitution, whose articles 43 and 49 establish the right of all citizens to protection of their health. The law recognizes

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864-464: A right to health services for all citizens and for foreigners resident in Spain. Second, Title VIII of the Constitution confers upon the autonomous communities broad purview in matters of health and health care. The autonomous communities have first-order importance in this area, and the law permits devolution of these functions from the central government to the autonomous communities, in order to provide

936-469: A sector ( Dirección de sector ), or of a comarca , district, department, or other territorial unit used in that autonomous community. Although the autonomous communities differ among themselves in layering subdivisions of their health areas, all eventually come down to a Health Zone ( Zona de Salud ) or Basic Health Zone ( Zona Básica de Salud ) as the unit for a primary health care team. In Andalusia, for example, each existing Basic Health Zone takes care of

1008-424: A substantial number of people, it may be termed as a pandemic . The declaration of an epidemic usually requires a good understanding of a baseline rate of incidence ; epidemics for certain diseases, such as influenza , are defined as reaching some defined increase in incidence above this baseline. A few cases of a very rare disease may be classified as an epidemic, while many cases of a common disease (such as

1080-512: A word form attributed to Homer 's Odyssey , which later took its medical meaning from the Epidemics , a treatise by Hippocrates . Before Hippocrates, epidemios , epidemeo , epidamos , and other variants had meanings similar to the current definitions of " indigenous " or " endemic ". Thucydides ' description of the Plague of Athens is considered one of the earliest accounts of

1152-497: Is a regulatory and autonomous agency of the Government of Spain that acts as the highest sanitary authority in the country in terms of medical safety on medicines , health products, cosmetics and personal care products . The agency is responsible for the regulation and authorization of clinical trials and the commercialization of sanitary products for human use, the planification and evaluation of those products along with

1224-427: Is a disease surveillance system. Tanzania , for example, runs a national lab that runs testing for 200 health sites and tracks the spread of infectious diseases. The next layer is the actual response to an emergency. According to U.S.-based columnist Michael Gerson in 2015, only the U.S. military and NATO have the global capability to respond to such an emergency. Still, despite the most extensive preparatory measures,

1296-713: Is abrupt - in this, two or more different strains of a virus , coinfecting a single host, combine to form a new subtype having a mixture of characteristics of the original strains. The best known and best documented example of both processes is influenza . SARS-CoV2 has demonstrated antigenic drift and possibly shift as well. Antibiotic resistance applies specifically to bacteria that become resistant to antibiotics . Resistance in bacteria can arise naturally by genetic mutation , or by one species acquiring resistance from another through horizontal gene transfer . Extended use of antibiotics appears to encourage selection for mutations which can render antibiotics ineffective. This

1368-421: Is especially true of tuberculosis , with increasing occurrence of multiple drug-resistant tuberculosis (MDR-TB) worldwide. Pathogen transmission is a term used to describe the mechanisms by which a disease-causing agent (virus, bacterium, or parasite) spreads from one host to another. Common modes of transmission include: - The first three of these require that pathogen must survive away from its host for

1440-542: Is established in the laws of autonomic financing. Inclusion of a new service in the catalog of services of the National Health System is accompanied by an economic memo that contains the positive or negative financial impact it is expected to imply. This memo is brought up to the Council of Fiscal Policy and Finance for analysis and approval as to whether to proceed. Prior to 1986, public financing of health care occurred mostly through highly regressive payroll taxes. In 1986,

1512-430: Is jointly composed, and coordinates the basic lines of health policy in matters affecting contracts; acquisition of health and pharmaceutical products, as well as other related goods and services; as well as basic health personnel policies. The 2003 Law of Cohesion and Quality of the SNS introduced significant changes in the composition, functioning, and purview of the CISNS. Under this law, the CISNS functions variously as

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1584-400: Is not immune. An example of this was the introduction European diseases such as smallpox into indigenous populations during the 16th century. A zoonosis is an infectious disease of humans caused by a pathogen that can jump from a non-human host to a human. Major diseases such as Ebola virus disease and salmonellosis are zoonoses. HIV was a zoonotic disease transmitted to humans in

1656-417: Is technically preferable. There are several factors that may contribute (individually or in combination) to causing an epidemic. There may be changes in a pathogen , in the population that it can infect, in the environment, or in the interaction between all three. Factors include the following: An antigen is a protein on the virus ' surface that host antibodies can recognize and attack. Changes in

1728-439: Is the rapid spread of disease to a large number of hosts in a given population within a short period of time. For example, in meningococcal infections , an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic. Epidemics of infectious disease are generally caused by several factors including a change in the ecology of the host population (e.g., increased stress or increase in

1800-479: Is usually restricted to smaller events. Any sudden increase in disease prevalence may generally be termed an epidemic. This may include contagious disease (i.e. easily spread between persons) such as influenza ; vector-borne diseases such as malaria ; water-borne diseases such as cholera ; and sexually transmitted diseases such as HIV/AIDS . The term can also be used for non-communicable health issues such as obesity . The term epidemic derives from

1872-497: The European Medicines Agency (EMA); the authorization of clinical laboratories, develop the specific rules to ensure the quality of the medical products and inspect all sanitary products of the central government competence. Since 1998, the agency has powers over the control, evaluation and authorization of animal health products. The agency was created under the name of Agencia Española del Medicamento by

1944-600: The Spanish Civil War , the Ley de Bases de 1944 perpetuated this . The Law of 14 December 1942 create a system of obligatory health insurance under the already extant National Insurance Institute ( Instituto Nacional de Previsión , INP). The system was based on a percentage tax linked to employment. This was further modified by the General Law of Social Security ( Ley General de la Seguridad Social ) in 1974, toward

2016-463: The antigenic characteristics of the agent make it easier for the changed virus to spread throughout a previously immune population. There are two natural mechanisms for change - antigenic drift and antigenic shift . Antigenic drift arises over a period of time as an accumulation of mutations in the virus genes , possibly through a series of hosts, and eventually gives rise to a new strain of virus which can evade existing immunity. Antigenic shift

2088-577: The bienio progresista , the Law of 28 November 1855 established the basis for a General Health Directorate ( Dirección General de Sanidad ), which was created a few years later and which would last into the 20th century. The Royal Decree of 12 January 1904 approved the General Health Instruction ( Instrucción General de Sanidad ), which altered little of the 1855 scheme besides the name; the name would later change to General Inspectorate of Health ( Inspección General de Sanidad ). After

2160-435: The common cold ) would not. An epidemic can cause enormous damage through financial and economic losses in addition to impaired health and loss of life. The United States Centers for Disease Control and Prevention defines epidemic broadly: "Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area." The term "outbreak" can also apply, but

2232-742: The Charles III Institute of Health ( Instituto de Salud Carlos III ), the Institute of Health Information ( Instituto de Información Sanitaria ), the Quality Agency of the National Health System ( Agencia de Calidad del Sistema Nacional de Salud ) and the Observatory of the National Health System ( Observatorio del Sistema Nacional de Salud ). The basic organ of cohesion is the Interterritorial Council of

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2304-533: The Councilors with purview over matters of health of the autonomous communities, elected by all of the Councilors who make up the body. The CISNS will come to know, debate among other things, and, as appropriate, make recommendations on the following matters: The prior functions shall be exercised without prejudice to the legislative purview of the Cortes Generales and, as appropriate, the norms of

2376-659: The Fiscal, Administrative and Social Order Measures Act of 1997 and its powers were extended (to fields such as veterinary drugs ) by another law of the same name from 1998 and by the Cohesion and Quality of the National Health System Act of 2003. The statute of the agency was approved in 1999. It was renamed as Agencia Española de Medicamentos y Productos Sanitarios in August 2003. It depends directly from

2448-613: The General Administration of the State; likewise the normal developmental, executive and organizational purview of the autonomous communities. Article 41 of the General Health Law establishes that: The State finances, through general taxes, all health benefits and a percentage of pharmaceutical benefits. This tax is shared among the several autonomous communities according to various sharing criteria now that

2520-639: The General Directorate of Advanced Therapies and Transplants ( Dirección General de Terapias Avanzadas y Trasplantes ). The General Health Law of 1986 created the Interterritorial Council of the Spanish National Health Service ( Consejo Interterritorial del Servicio Nacional de Salud , CISNS) as the organ of general coordination in matters related to health between the central State and the autonomous communities who were given authority in health matters under that law. It

2592-430: The General Health Law sets out that ayuntamientos — municipal governments —have the following responsibilities with respect to health, without prejudice to the purview of other public administrative bodies: As a consequence of the decentralization contemplated by the Spanish Constitution, each autonomous community has received adequate transfers to create a health service, the administrative structure that manages all of

2664-463: The Law of Cohesion establishes that the financing of the Spanish health system is the responsibility of the autonomous communities in conformity with the accords of transfer and the current system of autonomic financing, notwithstanding the existence of a third party liable to pay. Sufficient financing of services is determined by the resources assigned to the autonomous communities in conformity to what

2736-421: The Law of Cohesion, CISNS functions mainly through the adoption of and compliance with joint accords, through the political use of the plenary sessions, with each member making an uncompromising defense of the interests of its region. Presentations, committees, and working groups have been very important, some more than others. Important committees include: Articles 69, 70 and 71 of the Law of Cohesion regulate

2808-473: The National Health System. Therefore, the 2003 law establishes coordination and cooperation of public health authorities as a means to ensure citizens the right to health protection, with the common goal of ensuring equity, quality and social participation National Health System. The law defines a core set of functions common to all of the autonomous health services. Without interfering with the diversity of forms of organization, management and services inherent in

2880-556: The National Institute of Health Management, INGESA. Under Chapter III of the 1978 Spanish Constitution, all Spanish citizens are beneficiaries of public health services. Concretely, it establishes that: Further, the Organic Law 4/2000 ( Ley Orgánica 4/2000 ) establishes the rights and liberties of foreigners resident in Spain. Its effect on the healthcare provision can be seen in the following articles: Article 10 of

2952-495: The Spanish National Health Service ( Consejo Interterritorial del Servicio Nacional de Salud de España ), which has great flexibility in decision making, as well as mechanisms to build consensus and to bring together the parties taking such decisions. A system of inspection, the Alta Inspección , assures that accords are followed. The Royal Decree-Law 16/2012 was introduced on April 20, 2012. It puts into law severe cuts in

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3024-620: The Spanish National Health System, including the following: The Ministry of Health and Social Policy develops the policies of the Government of Spain in matters of health, in planning and delivery of services, as well as exercising the purview of the General Administration of the State to assure citizens the right to protection of their health. The ministry has its headquarters on the Paseo del Prado in Madrid , across

3096-471: The administrative document that accredits its holder and provides certain basic data. In order to best facilitate collaboration, quality, and continuity of services, the each card includes a standardized form of basic identification data for the holder, and indicates in which autonomic health service the person is enrolled. In particular, the cards incorporate a digital form of this information; health facilities throughout Spain have appropriate equipment to read

3168-405: The autonomous communities had gradually assumed purview in matters of health and had established stable models to finance the assumed purview. Meanwhile, in the 17 years since the original law, Spanish society had undergone many cultural, technological and socioeconomic changes that affected people's ways of life and affected the country's patterns of disease and illness. These posed new challenges to

3240-538: The beginning of the 19th century, the Balmis Expedition (1803) to administer the smallpox vaccine throughout the Spanish colonies was a public health undertaking of unprecedented geographical scope. The Cortes of Cádiz debated a sanitary code (the Código Sanitario de 1812 ), but nothing was approved due to lack of scientific and technical consensus about the actions to be undertaken. During

3312-419: The centers, services and establishments of the community itself, as well as its deputations, municipal governments, and whatever other territorial administrations fall within that community. The Law of Cohesion establishes the Interterritorial Council (CISNS) as the organ of coordination and cooperation of the SNS. In the autonomous cities of Ceuta and Melilla the corresponding health services are provided by

3384-573: The clinic as well as in the patient's home. Article 13 of the Law of Cohesion regulates characteristics of health care offered in Spain by medical specialists , which is provided at the request of primary care physicians. This may be in-patient hospital care or out-patient consultation at specialist centers or day hospitals . It includes care, diagnosis, therapy, rehabilitation and certain preventive care, as well as health promotion, health education and prevention of illness whose nature makes it appropriate to handle at this level. Specialized care guarantees

3456-527: The clinical history document is sometimes known as a "health history" ( historia de salud ) or "life history" ( historia de vida ). The Clinical History of the [Spanish] National Health System ( Historia Clínica Digital del Sistema Nacional de Salud , HCDSNS) is intended to guarantee citizens and health professionals access to whatever clinical information is relevant for medical care of a particular patient. This history should be available at all authorized locations, but nowhere else: except as needed for treatment,

3528-439: The combination of care for those patients, generally those with a chronic illness , whose would benefit from the simultaneous and synergistic provision of health services and social services to increase their personal autonomy, palliate their limitation or hardships, and facilitate their social reinsertion. This group includes: Epidemic An epidemic (from Greek ἐπί epi "upon or above" and δῆμος demos "people")

3600-489: The communities are responsible for health in their respective territories. Each year the CISNS, after deliberation, establishes the portfolio of services covered by the National Health System, which is published by a Royal Decree of the Ministry of Health. Each autonomous community then establishes its respective portfolio of services, which includes at least the service portfolio of the National Health System. Article 42 of

3672-422: The continuity of integrated patient care once the capabilities of primary care have been exhausted and until matters can be returned to that level. Insofar as patient condition allows, specialized care is offered in out-patient consultation and in day hospitals. As of 2010, Spain recognizes fifty distinct medical specialties. Article 14 of the Law of Cohesion defines social-health care ( atención sociosanitaria ) as

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3744-524: The density of a vector species), a genetic change in the pathogen reservoir or the introduction of an emerging pathogen to a host population (by movement of pathogen or host). Generally, an epidemic occurs when host immunity to either an established pathogen or newly emerging novel pathogen is suddenly reduced below that found in the endemic equilibrium and the transmission threshold is exceeded. An epidemic may be restricted to one location; however, if it spreads to other countries or continents and affects

3816-619: The development of the National Pandemic Preparedness Plan for Respiratory Viruses using a multisectoral approach. Preceding this national effort, a regional workshop on the Preparedness and Resilience for Emerging Threats (PRET) initiative was organized by WHO's South-East Asia Regional Office on October 12-13, 2023. Recognizing that the same capacities and capabilities can be leveraged and applied for groups of pathogens based on their mode of transmission,

3888-499: The digital information from the cards. A cardholder should thereby be able to access all the services of all relevant health professionals throughout the country. A patient's clinical history is a medical-legal document that arises from the interactions between health professionals and their clients. From a medical and legal point of view, the clinical history is the only document valid to track this history of interactions. In primary care, where methods of health promotion are important,

3960-408: The early part of the 20th century, though it has now evolved into a separate human-only disease. Some strains of bird flu and swine flu are zoonoses; these viruses occasionally recombine with human strains of the flu and can cause pandemics such as the 1918 Spanish flu or the 2009 swine flu . In a common source outbreak epidemic, the affected individuals had an exposure to a common agent. If

4032-600: The end of the Franco regime. Social Security had taken on an increasing number of diseases within its package of services, as well as covering a larger number of individuals and communities. The General Health Law ( Ley General de Sanidad ) of 25 April 1986 and the creation of Health Councils ( Consejerías de Sanidad ) and a Ministry of Health, fulfilled the mandate of the Spanish Constitution of 1978 , in particular Articles 43 and 49 which made protection of health

4104-650: The exposure is singular and all of the affected individuals develop the disease over a single exposure and incubation course, it can be termed as a point source outbreak. If the exposure was continuous or variable, it can be termed as a continuous outbreak or intermittent outbreak, respectively. In a propagated outbreak, the disease spreads person-to-person. Affected individuals may become independent reservoirs leading to further exposures. Many epidemics will have characteristics of both common source and propagated outbreaks (sometimes referred to as mixed outbreak ). For example, secondary person-to-person spread may occur after

4176-403: The following underlying factors: - Changes in behaviour can affect the likelihood or severity of epidemics. The classic example is the 1854 Broad Street cholera outbreak , in which a cholera outbreak was mitigated by removing a supply of contaminated water - an event now regarded as the foundation of the science of epidemiology . Urbanisation and overcrowding (e.g. in refugee camps ) increase

4248-404: The following years, immunity will decline, both within individuals and in the population as a whole as older individuals die and new individuals are born. Eventually, unless there is another vaccination campaign, an outbreak or epidemic will recur. It's also possible for disease which is endemic in one population to become epidemic if it is introduced into a novel setting where the host population

4320-419: The information is considered confidential and access is restricted. The term "Health Area" ( Área de Salud ) refers to an administrative district that brings together a functional and organizational group of health centers and primary care professionals. A Health Area may be exclusively focused on primary care or may include specialists as well. Some autonomous communities use different term, such as Direction of

4392-498: The law is the National Health System. The presumption underlying the adopted model is that in each autonomous community, authorities are adequately equipped with necessary territorial perspective, so that the benefits of autonomy do not conflict with the needs of management efficiency. The National Health System is thus conceived as the set of health services of the Autonomous Communities properly coordinated. Thus,

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4464-541: The law that established the Spanish National Health System also shifted financing toward progressive general taxes and away from payroll taxes. In a 2000 report, the World Health Organization ranked Spain 26th of 191 countries in its fairness in financing. In 1999, reform to income tax deductions allowed high income earners to deduct more for private insurance. Although this reform was intended to decrease overconsumption of health care services, it had

4536-415: The likelihood of disease outbreaks. A factor which contributed to the initial rapid increase in the 2014 Ebola virus epidemic was ritual bathing of (infective) corpses; one of the control measures was an education campaign to change behaviour around funeral rites. The level of immunity to a disease in a population - herd immunity - is at its peak after a disease outbreak or a vaccination campaign. In

4608-433: The market. It has been argued to be the beginning of deregulation. The General Health Law was complemented in 2003 by the Law of Cohesion and Quality of the National Health System ( Ley 16/2003 de cohesión y calidad del Sistema Nacional de Salud ), which maintained the basic lines of the General Health Law, but modified and broadened the articulation of that law to reflect existent social and political reality. By 2003, all of

4680-545: The participation of the autonomous communities. Among these are the Agency of Evaluation of Technologies ( Agencia de Evaluación de Tecnologías , Spanish Agency of Medicines and Medical Devices ( Agencia Española de Medicamentos y Productos Sanitarios ), the Human Resources Committee ( Comisión de Recursos Humanos ), the Committee to Assess Health Research ( Comisión Asesora de Investigación en Salud ),

4752-485: The principal functions of the Interterritorial Council of the SNS. The principal aspects of the Interterritorial Council are: The Interterritorial Council is constituted by the Minister of Health and Consumer Affairs [now of Health and Social Policy], who holds its presidency, and by the Councilors with purview over matters of health of the autonomous communities. The vicepresidency of the body will be fulfilled by one of

4824-604: The rest of Europe, particularly among the physicians of the Golden age of Jewish culture in Spain . In the years after the Reconquista , the Real Tribunal del Protomedicato regulated the practice of medicine in Spain and in its colonies. However, the system of medical faculties at the various universities was very decentralized. Surgery and pharmacy were quite separate from medicine and were considerably less prestigious;

4896-429: The side effect of more regressive financing of public health services. Nevertheless, that same year payroll taxes were completely phased out while higher indirect taxes (on excise goods such as alcohol and tobacco) were earmarked for health care. Article 57 of the Law of Cohesion establishes that citizens' access to health services will be facilitated by use of an individual health card ( tarjeta sanitaria individual ), as

4968-611: The street from the Museo del Prado . The Royal Decree 1041/2009 of 29 June lays out the basic organic structure of the Spanish Ministry of Health and Social Policy. From the date of that decree, the new ministry assumed the functions of, and superseded the former Ministry of Health and Consumption ( Ministerio de Sanidad y Consumo ) and Secretary of State for Social Policy, Family, and Attention to Dependency and Disability ( Secretaría de Estado de Política Social, Familia y Atención

5040-643: The systems of Galen and Hippocrates dominated medical practice during most of the era of the Antiguo Régimen . Medicine was one of the principal fields of activity for the novatores of the late 17th century, but their initiatives were individualized and localized. There is some continuity from their work to the broader work during the Age of Enlightenment , such as through the Colegio de Cirugía de San Carlos ("San Carlos College of Surgery") in Madrid . At

5112-409: The various health services fall under the responsibility of the respective autonomous communities, but also under basic direction and coordination by the central state. The respective health services of the autonomous communities would gradually realize a transfer of health resources from the central government to the autonomous communities. The law of 1997 allowed private health care companies to enter

5184-503: The workshop aimed to facilitate pandemic planning efficiency for countries in the region. The participating countries, in the aftermath of the workshop, outlined their immediate next steps and sought support from WHO and its partners to bolster regional preparedness against respiratory pathogen pandemics. Spanish Agency of Medicines and Medical Devices The Spanish Agency of Medicines and Medical Devices ( Spanish : Agencia Española de Medicamentos y Productos Sanitarios ; AEMPS )

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