Implantación del servicio de indicación farmacéutica en farmacia comunitaria en España: INDICA+PRO Implantación (2020-2021) / Implementation of the pharmaceutical indication service in community pharmacies in Spain: INDICA+PRO Implementation (2020-2021)

JUSTIFICACIÓN: INDICA+PRO es un estudio de implantación que tiene como objetivo la incorporación del servicio de indicación farmacéutica (SIF) protocolizado en la práctica diaria de la farmacia comunitaria (FC). Se ha estimado que el 25 % del tiempo del farmacéutico en España se dedica a la atención del paciente con síntomas menores. Tras la evaluación de un estudio de impacto que mostró resultados clínicos, humanísticos y económicos positivos en Valencia, se llevó a cabo el estudio INDICA+PRO Implantación para incrementar dicho impacto a escala nacional.OBJETIVOS: desarrollar y evaluar los resultados de un programa de implantación del SIF en la farmacia comunitaria española.MATERIAL Y MÉTODOS: diseño híbrido de efectividad-implantación tipo 3 con una duración inicial de 14 meses. La intervención constaba de diferentes elementos: procedimiento general del SIF establecido por Foro de Atención Farmacéutica en Farmacia Comunitaria, protocolos consensuados entre sociedades médicas (Semergen y SemFyC), asociaciones farmacéuticas (SEFAC y MICOF) y universidad (GIAF-UGR) específicos para 31 síntomas menores incluidos en una plataforma digital (SEFAC e_XPERT®) y la formación de los farmacéuticos con el seguimiento de 33 farmacéuticos facilitadores del cambio de práctica. Los pacientes recibieron seguimiento tras 10 días de la consulta en farmacia. Se utilizó un marco teórico para la implantación de servicios en FC. (AU)

Diseño y desarrollo del servicio de cribado de sufrir fractura osteoporótica del MICOF de Valencia / Design and development of the screening service for osteoporotic fractures at the MICOF in Valencia

JUSTIFICACIÓN: la osteoporosis es una patología asintomática que se desarrolla de manera lenta pero progresiva sin mostrar síntomas ni signos aparentes; una de las consecuencias de esta enfermedad son las fracturas osteoporóticas y dadas sus consecuencias clínicas y morbimortalidad, supone un importante problema de salud pública en los países desarrollados.OBJETIVOS: diseñar y desarrollar un servicio de identificación de personas en riesgo de padecer fracturas osteoporóticas desde la farmacia comunitaria e incorporarlo en el Catálogo de Servicios Profesionales del MICOF.MATERIAL Y MÉTODOS: se ha realizado una revisión bibliográfica de documentos de sociedades científicas con respecto a las herramientas de cribado para evaluar el riesgo de sufrir fracturas osteoporóticas en función de los factores de riesgo individuales. No existe ningún consenso específico aceptado a nivel nacional ni mundial, sin embargo, de entre todas las escalas, la más utilizada en la práctica clínica para evaluar el riesgo de fractura es la escala FRAX®.RESULTADOS: tras la revisión se decide utilizar el algoritmo propuesto por SEFAC en su curso sobre Osteoporosis consistente en identificar y clasificar los factores de riesgo clínicos, y en evaluar el riesgo de padecer fracturas a través de la escala FRAX®. En aquellos pacientes con un riesgo elevado o intermedio se derivará al médico para la valoración de la realización de una densitometría además de una intervención farmacéutica en estilo de vida (nutrición y actividad física) en prevención primaria y secundaria de la osteoporosis. (AU)

Knowledge, actual and potential use of HIV self-sampling testing kits among MSM recruited in eight European countries.

AIM: To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method. METHODS: We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence. RESULTS: A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result. CONCLUSION: The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.

Incident risk factors as predictors of HIV seroconversion in the Lisbon cohort of men who have sex with men: first results, 2011-2014.

HIV incidence in men who have sex with men (MSM) is increasing in western countries, including Portugal. We aimed to estimate HIV incidence and to assess how individual short-term changes in exposures over time predict seroconversion. We evaluated participants of an open cohort of HIV-negative MSM enrolled after testing at a community-based voluntary HIV counselling and testing centre in Lisbon. At each evaluation a structured questionnaire was completed and HIV status was ascertained using rapid followed by confirmatory testing. Between April 2011 and February 2014, 804 MSM were followed for a total of 893 person-years. Predictors of HIV seroconversion were identified using Poisson generalised linear regression. The overall seroincidence was 2.80/100 person-years (95% confidence interval: 1.89-4.14). Men who seroconverted had a higher mean number of tests per year. Seroconversions were significantly associated with partner disclosure of HIV status during follow-up, newly-adopted unprotected anal intercourse (UAI) with a steady partner and being newly-diagnosed with syphilis during follow-up. Likewise, sexual intercourse with HIV-positive men, having an HIV-positive steady partner at least once during follow-up and persistent UAI with occasional partners were predictors of seroconversion. High HIV incidence in this cohort is likely driven by short-term contextual and behavioural changes during follow-up.

HIV testing among Portuguese men who have sex with men--results from the European MSM Internet Survey (EMIS).

OBJECTIVES: To describe HIV testing behaviour and context of MSM in Portugal participating in the European MSM Internet Survey (EMIS). METHODS: Data for the Portuguese sample were extracted and those for 5187 participants were analysed. Multivariate logistic regression models were fitted to quantify the association between participants' characteristics and HIV testing behaviour and context. RESULTS: Seventy-two percent of the participants had ever been tested for HIV and among those ever tested, 11% were diagnosed with HIV. Primary care was the most common testing setting for HIV-negative men (37%). Compared to those never tested, men who had ever taken an HIV test had higher educational level (aOR 1.89, 95% CI 1.67-2.14) and identified themselves as gay/homosexual more frequently (aOR 1.94 , 95% CI 1.70-2.20). HIV testing odds significantly increased with the number of sexual partners in the previous 12 months. Those who reported unprotected anal intercourse (UAI) with a partner of unknown or serodiscordant HIV status in the previous 12 months were less likely to report an HIV test (aOR 0.38, 95% CI 0.33-0.44). Among those never tested or who tested negative, 41% and 22% reported UAI with a partner of unknown or serodiscordant status in the previous 12 months, respectively. Among men with diagnosed HIV, 72% were currently on antiretroviral therapy and 58% reported an undetectable viral load. More than one third (38%) of those who had detectable or unknown/undisclosed viral load reported at least one episode of UAI with a partner of unknown or serodiscordant HIV status in the last 12 months. CONCLUSIONS: Actual interventions should focus on: improving testing uptake and counselling; increasing treatment coverage; achieving and maintaining an undetectable viral load; and intensifying prevention efforts focused on consistent condom use.

Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain.

This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure finished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant "short term" result after having ended the intervention, when either MT or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.

Do community mental health teams caring for severely mentally ill patients adjust treatments and services based on patients' antisocial or criminal behaviours?

BACKGROUND: Antisocial behaviour is common among patients with severe mental illness (SMI) requiring hospitalisation. AIM: To determine whether differential treatments and services are provided to patients with SMI who engage in antisocial behaviour. METHOD: A random sample of 161 inpatients with SMI were recruited from general adult wards and assessed at baseline and two years later. Information on symptoms, aggressive behaviour, substance misuse, and service use was obtained from patients and clinical files. RESULTS: Past antisocial behaviours were not associated with type or intensity of treatments and services. Severity of positive symptoms, aggressive behaviour, and illicit drug use were positively associated with the frequency of CMHT contact, but not with the type of CMHT, type of medication, or other treatments and benefits. CONCLUSIONS: While the frequency of meetings with CMHTs increased with the severity of antisocial behaviours, no specific treatments were provided to patients with SMI engaging in antisocial behaviours.

Semichemical pulping of Miscanthus giganteus. Effect of pulping conditions on some pulp and paper properties.

Miscanthus is an interesting raw material for pulp production, it is a high yield low maintenance plant with a high cellulose and hemicellulose content. Its semichemical pulp can be beneficial in paper for cardboard production process, which nowadays is usually made from secondary fibers, by increasing the mechanical properties of the paper produced. In this study, the influence of the percentage of NaOH used related to the dry Miscanthus weight, digestion time and refining time on some pulp and paper properties have been studied and compared with pulp obtained from commercial fluting paper (CF). Fiber size distribution of the Miscanthus pulp was found to contain a higher fines (less than 0.2mm) percentage than the CF pulp. Hand-sheets made from Miscanthus pulp showed better mechanical properties than the ones made with the CF pulp. CMT, RCT and CCT indexes were higher when using 100% Miscanthus pulp or mixtures of Miscanthus and CF pulp. The only property which worsened was Gurley porosity. Of the three operational variables changed, refining time exerts the most significant influence on the pulp and paper properties measured.

Estudio de la calidad de vida profesional en los trabajadores de atención primaria del Área 1 de Madrid / Study of the professional quality of life of primary care workers in Madrid Area 1

No disponible

[Primary care doctors needs for information: analysis of questions and how they were answered]. / Necesidades de información de los médicos de atención primaria: análisis de preguntas y su resolución.

OBJECTIVE: To assess what information primary care doctors from 5 health areas of Madrid need, through the description of the frequency and kind of clinical questions that arise, the pattern of search for the answers and how well they were answered. DESIGN: Descriptive, observational study. Setting. Primary care consultations in health areas 1, 3, 8, 9, and 10, Madrid, Spain. PARTICIPANTS: Randomised sample, stratified by zone, and kind of doctor, of 125 doctors from each area (Madrid). Residents, locums, and university teachers were excluded. INTERVENTIONS: Doctors will be invited to be observed by video camera for about four hours of on-demand consultation. They will be asked between patients to specify the questions that arise and the sources of information used in the consultation. Unresolved questions will be followed up by means of phone contact 2 weeks later, to see whether they had found answers and what methods they used to find them. MAIN VARIABLES: number of recognised clinical questions formulated and their answers; number of clinical questions not recognised (as observed by video); each question's theme and kind of information; time used to look for answers; information resources used. Other variables: characteristics of the PC professionals taking part, consultations, health centres, and case-loads. DISCUSSION: Restrictions: Hawthorne effect or bias in the person observed and participants stage fright. Applicability: the results of the research will be used to plan the resources needed for doctors to enjoy and put into practice the best scientific knowledge.

Necesidades de información de los médicos de atención primaria: análisis de preguntas y su resolución / Primary care doctors’ needs for information: analysis of questions and how they were answered

Objetivo. Determinar las necesidades de información de los médicos de atención primaria de 5 áreas de salud de Madrid mediante la descripción de la frecuencia y el tipo de preguntas clínicas, el patrón de búsqueda y nivel de resolución de éstas. Diseño. Estudio observacional descriptivo. Emplazamiento. Consultas de atención primaria. Áreas de salud 1, 3, 8, 9 y 10 de Madrid. Participantes. Muestra aleatoria, estratificada por zona y tipo de médico, de 125 médicos de cada una de las áreas (Madrid). Se excluye a los médicos residentes, a los suplentes y a los que realizan actividades de enseñanza universitaria. Intervenciones. Se invitará a los médicos a ser observados mediante cámara de vídeo durante aproximadamente 4 h de consulta a demanda. Se les pedirá que especifiquen, entre paciente y paciente, las preguntas que surjan y las fuentes de información utilizadas dentro de la consulta. Las preguntas sin resolver serán seguidas mediante contacto telefónico 2 semanas después para determinar si se han obtenido respuestas y los métodos utilizados. Mediciones principales. Variables principales: número de preguntas clínicas formuladas reconocidas y sus respuestas; número de preguntas clínicas no reconocidas (observadas a través del vídeo); tema y tipo de información de cada pregunta; tiempo utilizado en buscar respuestas; recursos de información utilizados. Otras variables: características de los profesionales de atención primaria participantes, consultas, centros de salud y presión asistencial. Discusión. Una limitación es el efecto Hawthorne o sesgo del observado y miedo escénico de los participantes. En cuanto a la aplicabilidad de los resultados de la investigación, servirán para planificar los recursos necesarios para que los médicos dispongan y apliquen la mejor evidencia científica

Objective. To assess what information primary care doctors from 5 health areas of Madrid need, through the description of the frequency and kind of clinical questions that arise, the pattern of search for the answers and how well they were answered. Design. Descriptive, observational study. Setting. Primary care consultations in health areas 1, 3, 8, 9, and 10, Madrid, Spain. Participants. Randomised sample, stratified by zone, and kind of doctor, of 125 doctors from each area (Madrid). Residents, locums, and university teachers were excluded. Interventions. Doctors will be invited to be observed by video camera for about four hours of on-demand consultation. They will be asked between patients to specify the questions that arise and the sources of information used in the consultation. Unresolved questions will be followed up by means of phone contact 2 weeks later, to see whether they had found answers and what methods they used to find them. Main measurements. Main variables: number of recognised clinical questions formulated and their answers; number of clinical questions not recognised (as observed by video); each question's theme and kind of information; time used to look for answers; information resources used. Other variables: characteristics of the PC professionals taking part, consultations, health centres, and case-loads. Discussion: Restrictions: Hawthorne effect or bias in the person observed and participants´ stage fright. Applicability: the results of the research will be used to plan the resources needed for doctors to enjoy and put into practice the best scientific knowledge

Riboflavin requirements of Filipino children and non-pregnant, pregnant and lactating women: Studied by the erthrocyte glutathione reductase activation test.

Riboflavin requirements were studied in six non-pregnant, 12 pregnant, 11 lactating women, 20 children aged 4-6 years and 14 children aged 10-12 years. All subjects initially were riboflavin-deficient with erythrocyte glutathione reductase activation coefficient (EGR-AC) of >=1.3, confined in a metabolic ward and repleted with increasing doses of riboflavin during four 10 or 8 day feeding periods. The repletion diet simulated the usual basal diet of the subjects but were modified to contain adequate energy and protein in the pregnant group. Minimum riboflavin requirements determined by regression analysis as intakes required to obtain an EGR-AC value of < 1.3 were: 0.72 ± 0.09 (non-pregnant); 1.36 ± 0.37 (pregnant); 1.31 ± 0.16 (lactating); 0.58 ± 0.10 (children 4-6 years), and 0.70 ± 0.18 mg/d (children 10-12 years). Riboflavin requirements in mg/d, mg/1000 kcal, mg/g protein or mg/kg metabolic body size for the groups varied. Because of the large variability, the use of a single value relating riboflavin requirement to either energy,protein requirements or metabolic body size to calculate requirements for different age groups or gender is deemed inappropriate. It is recommended that riboflavin requirements be expressed in mg/d as determined experimentally for different population groups. Estimated recommended dietary allowances for the groups studied, obtained by adding 30% to the mean minimum riboflavin requirement, are presented.

Vitamin A status of Filipino preschool children given a massive oral dose.

The protection period of a 200,000 IU of vitamin A on Filipino children was determined. Subjects were 105 children aged 1-5 years given a single massive dose during the "Araw ng Sangkap Pinoy" (ASAP) in March 1995. Serum retinol was measured by HPLC at baseline, one, two, four and six months after the administration of the dose. Results showed that baseline serum retinol levels were significantly lower than all follow-up values. Serum retinol values were maintained at levels higher than pre-supplementation values although the values decreased on the second month after supplementation. The proportions of deficient and low (< 20 microg/dl) levels were significantly lower one and six months after supplementation. All follow-up serum retinol levels of children with deficient and low values at baseline were significantly lower (p < 0.001) than those with normal values. The WHO recommendation of 200,000 IU was effective in increasing serum retinol concentrations and maintaining it above pre-supplementation levels up to 6 months after administration of the dose. It also replenished organic vitamin A reserves as shown by the dose response (S30DR) approach. Incidence of infection also decreased among the children. Supplementation with vitamin A has likewise resulted in an increase in hemoglobin values and a decrease in the proportion of anemics (Hb < 11.0 g/dl) among the children.

[In vitro granulopoietic cultures. Analysis using monoclonal antibodies]. / Cultivos granulopoyéticos in vitro. Análisis con anticuerpos monoclonales.

Four monoclonal antibodies were applied, using an immunoenzymatic technique, the alkaline phosphatase anti-alkaline phosphatase, in granulopoietic cultures in vitro. In this manner, granulopoietic growth at tenth day of culture has been defined as positive for myeloid markers (CD15, CD11b) and negative for macrophagic (CD68) and proliferating cells (Ki 67) markers.