The -514C>T polymorphism in the LIPC gene modifies type 2 diabetes risk through modulation of HDL-cholesterol levels in Mexicans.

PURPOSE: Both type 2 diabetes (T2D) and low levels of high-density lipoprotein cholesterol (HDL-C) are very prevalent conditions among Mexicans. Genetic variants in the LIPC gene have been associated with both conditions. This study aimed to evaluate the association of the -514C < T (rs1800588) LIPC gene polymorphism with different metabolic traits, particularly the effects of this polymorphism on HDL-C plasma levels and T2D risk. METHODS: Mediation analysis was used to assess the direct and indirect effects of the -514C>T LIPC gene variant on HDL-C levels, T2D risk, and body mass index (BMI), in 2105 Mexican mestizo participants. We also assessed the functional effect of the -514C>T LIPC variant on the promoter activity of a reporter gene in the HepG2 cell line. RESULTS: Direct effects show that the -514C>T LIPC polymorphism is significantly associated with increased HDL-C plasma levels (ß = 0.03; p < 0.001). The -514C>T variant resulted in an indirect protective effect on T2D risk through increasing HDL-C levels (ß = - 0.03; p < 0.001). Marginal direct association between -514C>T and T2D was found (ß = 0.08; p = 0.06). Variables directly influencing T2D status were European ethnicity (ß = - 7.20; p < 0.001), age (ß = 0.04; p < 0.001), gender (ß = - 0.15; p = 0.017) and HDL-C (ß = - 1.07; p < 0.001). In addition, we found that the -514C>T variant decreases the activity of LIPC promoter by 90% (p < 0.001). CONCLUSIONS: The -514C>T polymorphism was not directly associated with T2D risk. HDL-C acts as a mediator between -514C>T LIPC gene variant and T2D risk in the Mexican population.

[Trends in the incidence of venous thromboembolism in Galicia over a ten year period]. / Evolución de la incidencia de la enfermedad tromboembólica venosa en Galicia durante diez años (2006-2015).

OBJECTIVE: To analyse the trend of serious thromboembolic episodes in Galicia from 2006 to 2015. METHODS: A retrospective observational study was performed using the public network of the Galician Health Service over the 10 year period (2006-2015). It included patients with a primary diagnosis in their discharge report of pulmonary thromboembolism (PTE), stroke, or deep vein thrombosis (DVT). DATA SOURCE: Servizo de admisión e documentación clínica, Subdirección de Información e Servizos Tecnolóxicos e Instituto Galego de Estatística. Measurement variables: the number of new cases of thromboembolism occurred in one year, cumulative incidence (number of new cases/ 100,000 persons years), mortality during hospital admission, and annual percentage change (APC). RESULTS: A total of 50,611 hospital admissions due to a venous thromboembolic event were identified. The highest incidence was found for stroke in men aged 80 years or older, with 940.84 new cases per 100,000 population per year. All thromboembolic events were more common in men, with the exception of PTE in young and older women. A continued increased was identified in all the thromboembolic events with an APC of 2.20%. The temporal evolution of the cumulative incidence for PTE was split into two segments, with an annual increase of 10.65% from 2006 to 2011, and a smaller increase since 2011. The cumulative incidence trend showed an APC for stroke of 1.56%. CONCLUSION: This study reveals an increase in the evolutionary trend of hospital admissions for PTE and stroke during the period 2006-2015 in Galicia.

Haemoglobin responses to transfusion in severe iron deficiency anaemia: potential impact of gastrointestinal disorders.

BACKGROUND AND OBJECTIVES: Red blood cell (RBC) transfusion may be justified in iron deficiency anaemia (IDA) when an increase in oxygen delivery is needed, as sometimes occurs in subjects with haemoglobin <8·0 mg/dL, serious comorbidities or at risk of cardiovascular instability. Earlier investigations showed that some patients with severe IDA requiring transfusion had lower than expected post-transfusion haemoglobin levels with poorer clinical outcomes than other patients. After hypothesizing that haemoglobin responses to transfusion were different and that the underlying gastrointestinal (GI) disorders causing IDA could be a confounder explaining this association, these responses were analysed in a prospective cohort of IDA adults referred for outpatient GI investigation. MATERIALS AND METHODS: Transfused patients with proven IDA, baseline haemoglobin at referral <9·0 g/dL and no extraintestinal bleeding were eligible. To assess a homogeneous population, only GI disorders known to cause occult bleeding were considered. Haemoglobin increments per 100 mL of RBCs were investigated. RESULTS: In total, 2818 patients were enrolled over 10·5 years. On multivariable regression, diffuse angiodysplasias and GI cancer independently predicted for reduced increments in post-transfusion haemoglobin [adjusted regression coefficients: -0·082 (95% confidence interval, -0·093 to -0·072) and -0·073 (95% confidence interval, -0·081 to -0·066), respectively, P < 0·001 in both]. Haemoglobin responses in the remaining bleeding disorders were adequate and agreed with the principle that one RBC unit increases the haemoglobin an average of 1 g/dL. CONCLUSION: The potential differential impact of GI disorders on changes in haemoglobin levels after RBC transfusion could be useful for transfusing physicians, especially for diagnostic purposes.

Prevalencia y factores sociodemográficos que condicionan el uso de joyas (y la percepción del riesgo de accidentes que conlleva) en niños menores de dos años / Sociodemographic prevalence and factors that condition the use of jewellery (and the perceived risk of accidents involved in children less than two years old)

Objetivos: conocer la prevalencia del uso de joyas (y la percepción del riesgo que conlleva) en niños menores de dos años de edad y establecer los factores sociodemográficos y culturales que lo determinan. Material y métodos: se diseñó un estudio observacional descriptivo transversal. Se realizó un cuestionario a padres en las consultas de Pediatría de cuatro áreas asistenciales durante seis meses. Las variables de caracterización referidas a los lactantes fueron: edad, sexo, número de hermanos, orden y convivientes. Las referidas a los padres: edad, sexo, nivel de estudios, profesión, país de origen, lugar de residencia y religión. Y las referidas a las joyas: tipo, material, procedencia, uso, tiempo, motivos y situaciones de uso. Así mismo, se preguntó sobre la percepción del riesgo de accidentes asociado. Resultados: se contabilizaron 319 cuestionarios. Las personas que regalaron joyas a los lactantes fueron con mayor frecuencia los familiares en primer grado (74,1%). Entre los riesgos de lesión potencial atribuidas a su uso, destacaron el estrangulamiento por cadenas (63,7%) y el atragantamiento por anillos (19,9%). El 40% de los hijos cuyos padres conocían algún caso de accidente por joyas usaba al menos una. Tenían más joyas los niños de mayor edad, aunque predominaba su uso en los menores de seis meses. Los padres de los niños más pequeños y de los mayores, dentro del rango de edad estudiado, eran los que percibían mayor riesgo en el uso de las joyas. Conclusiones: el uso de joyas entre los lactantes fue muy frecuente. Sus familias no mostraron una clara percepción de riesgo respecto a este hábito y tampoco habían recibido la información suficiente como para evitarlo (AU)

Objectives: to determine the prevalence of jewels use (and the perception of risk involved) in children under two years old and establish the sociodemographic and cultural factors that determine it. Materials and methods: we designed an observational descriptive transversal study. We conducted a questionnaire to parents in the pediatric outpatient clinics of 4 health areas during six months. The descriptive variables concerning infants were age, sex, number of siblings, order and cohabitants. Parents’ variables were age, sex, educational level, occupation, country of origin, place of residence and religion. Relating to jewels: type, material, origin, use, time, subject and situation of use. We also asked about the associated risk of accidents perceived. Results: there were 319 questionnaires. People that gave jewels to infants were more often first-degree relatives (74.1%). The risks of potential injury attributed to its use emphasized strangulation by chains (63.7%) and choking by rings (19.9%). Forty percent of children, whose parents knew cases of jewels’ accidents, used at least one. The older children had more jewels, although its use in the minors of 6 months predominated. The parents of the smallest and eldest children, within the studied rank of age, were those that perceived a major risk in the use of jewels. Conclusions: jewel use among infants was very frequent. Their families did not show a clear perception of risk respecting to this habit and they had not either received the sufficient information to avoid it (AU)

Cambio en la accesibilidad a la píldora poscoital y análisis de la influencia sobre la incidencia en las infecciones de transmisión sexual / Change in the accesibility of the emergency contraceptive pills and analysis concerning the influence on the incidence of sexually transmitted disease

Introducción: En España se ha puesto en marcha la dispensación gratuita de la píldora poscoital en los servicios de urgencias de atención primaria, lo que permite el acceso rápido y gratuito a las usuarias. Objetivos: Evaluar la influencia que ha tenido la administración gratuita de la píldora poscoital en atención primaria sobre su consumo, y comparar su evolución con las tendencias evolutivas de la incidencia de infecciones de transmisión sexual(ITS). Material y método: Estudio observacional y descriptivo. Se incluyeron datos de consumo de la píldora poscoital en farmacias y centros de salud e ITS de declaración obligatoria durante un periodo de 6 años (2002-2007). Variables de medida: tasa de consumo anual (consumo en número de envases de píldora poscoital por 1.000 habitantes y año), incidencia (número de nuevos casos acontecidos en un año) y tasa de incidencia (por 100.000 habitantes) para la sífilis e infecciones gonocócicas. Resultados: Tasa de consumo de la píldora poscoital al inicio del estudio (dispensación en oficinas de farmacia) de 3,02 frente a 12,44 en el año 2007. La tendencia al aumento de la tasa de consumo total de la píldora poscoital se relacionó de manera significativa (p= 0,024) y de tipo lineal con la tendencia al aumento de la incidencia de sífilis. Conclusiones: Se detecta un elevado incremento del consume de la píldora poscoital y una probable asociación con el aumento de la incidencia de sífilis (AU)

Introduction: In Spain they have implemented, the free dispensing of the emergency contraceptive pills in the primary care emergency departments, which allows the rapid and free access for the users. Objective: To evaluate the influence that free administration of emergency contraception in Primary Care has had on its consumption and compare the evolution of consumption of the above mentioned over time with incidence of sexually transmitted diseases (STDs). Materials and Method: Descriptive observational study Data on the consumption of the emergency contraceptive pill from drugstores and health centres of Obligatorily Declared sexually transmitted diseases were collected over 6 years (2002-2007). Main outcome measures: Annual level of consumption (consumption in number of emergency contraceptive pill boxes per 1,000 inhabitants per year, incidence (number of new cases detected in a year), and incidence rate (incidence per 100,000 inhabitants) for syphilis and gonococcal infections. Results: The consumption rate of the emergency contraceptive pill at the beginning of the study (distributed in drugstores) was3.02 versus to 12.44 in the year 2007. The tendency of the consumption rate of the emergency contraceptive pill to increase was found to be significant (p=0.024) and lineally related with the tendency of the syphilis rate to increase. Conclusions: An increased consumption of the emergency contraceptive pill and a probable association with the increase in the occurrence of syphilis was detected (AU)

Onicomicosis en un niño de 18 meses / Onychomycosis in an 18-month-old boy

La onicomicosis es una infección fúngica rara en niños. Las uñas de los pies se afectan con más frecuencia que las de las manos y, como en los adultos, Trichophyton rubrum es el agente causal más común. Clínicamente, se manifiesta por hiperqueratosis, roturas en el borde libre distal, pérdida de brillo de la superficie de la lámina ungueal y coloración blanco-amarillenta. El diagnóstico precoz permite no retrasar el inicio del tratamiento, evita la extensión de la infección y previene la distrofia ungueal. En la población infantil el tratamiento tópico puede ser de elección. En los últimos años se ha apreciado un incremento de la prevalencia de la onicomicosis en niños, por lo que esta entidad debe considerarse dentro del diagnóstico diferencial de las alteraciones ungueales. Se presenta el caso de un lactante diagnosticado de onicomicosis. El germen aislado fue Trichophyton mentagrophytes. Se trató con griseofulvina oral y ciclopirox olamina por vía tópica, con buena evolución (AU)

Onychomycosis is a fungal infection of the nails that is rare in children. The toenails are affected more frequently than the fingernails and, as in adults, Trichophyton rubrum is the most common causative pathogen. Onychomycosis can manifest clinically as hyperkeratosis, splintering of the free distal border, loss of luster of the surface of the nail plate and yellowish white coloration. Early diagnosis avoids delays in initiating treatment and prevents the extension of the infection and the development of nail dystrophy. In the pediatric population, topical treatment may be the first choice. In recent years, there has been an increase in the prevalence of onychomycosis in children. Thus, this disease must be considered in the differential diagnosis of nail disorders. We report the case of an infant with a diagnosis of onychomycosis. The pathogen isolated was Trichophyton mentagrophytes. He was treated with oral griseofulvin and topical ciclopirox with a positive outcome (AU)

Evaluación de la actitud y las dificultades que los médicos de Atención Primaria tienen ante el diagnóstico y el tratamiento del sobrepeso y la obesidad / Evaluation of the attitude and difficulties of Primary Care doctors regarding diagnosis and treatment of overweight patients and obesity

INTRODUCCIÓN. El conocimiento de los problemas que dificultan el manejo de la obesidad ayudará a desarrollar estrategias para su abordaje. El objetivo del presente trabajo es evaluar la actitud de los médicos de Atención Primaria con respecto al diagnóstico y el tratamiento del sobrepeso y la obesidad y conocer los problemas que dificultan su manejo. MATERIAL Y MÉTODO. Estudio transversal con muestreo aleatorio. Emplazamiento: centros de Atención Primaria de Galicia. Participantes: médicos de Atención Primaria. Cuestionario autoaplicable validado de 61 ítems que exploran variables sociodemográficas, medios, procedimientos, actitudes y necesidades. RESULTADOS. Se distribuyeron 200 cuestionarios. Tasa de respuesta: 63%. Varones, 48,15%; mujeres, 51,58%. Edades: el 59,26% entre 45-54 años y el 29,63% entre 35-44 años. Tiempo por consultas a demanda: 5,42 ± 1,73 min. El 83,33% considera la falta de tiempo por la presión asistencial, el 68,52% declara falta de formación en dietas individualizadas, para el 72,22% los pacientes no aceptan la obesidad como problema de salud y para el 77,78%, éstos no colaboran. El 64,88% siente frustración ante la dificultad para conseguir que los pacientes pierdan peso. El 89,19% de los médicos consideran que disponer de más tiempo, más formación (92,59%) y profesionales con formación específica (87,04%) mejoraría la atención a la obesidad. CONCLUSIONES. Los médicos mayoritariamente consideran problemas: la falta de percepción por los pacientes de la obesidad como problema de salud y la negativa a reconocer sus malos hábitos alimentarios, la presión asistencial y la falta de formación. Hay frustración y dificultad para conseguir y mantener objetivos de peso aceptables (AU)

INTRODUCTION. Being aware of the problems that make it difficult to manage obesity will help to develop strategies to deal with it. This paper aims to evaluate the attitude of the Primary Care doctors regarding the diagnosis and treatment of overweight patients and obesity and to define the problems that challenge its proper management. MATERIAL AND METHOD. A cross-sectional random sample study. Location: Primary Care centers in Galicia. Participants: Primary Care doctors. Method: a 61-item self-completed questionnaire that examines sociodemographic variables, resources, procedures, attitudes and needs. RESULTS. Two hundred questionnaires were distributed with a response rate of 63%. Men: 48.15% and women: 51.58%. Age: 59.26% were between 45-54 years and 29.63% between 35-44 years. Time for consultation upon request 5.42 ± 1.73 min. A total of 83.33% of the doctors surveyed consider these problems to be lack of time due to care pressure, 68.52% lack of training about individualized diets, 72.22% that patients do not accept obesity as a health problem and do not cooperate (77.78%). A total of 64.88% express feeling frustra- ted regarding the difficulty they have to get their patients to lose weight. 89.19% of the doctors consider that having more time, more training (92.59%) and professionals with specialized training (87.04%) would improve obesity care. CONCLUSIONS. Most of the doctors consider that the problems are lack of awareness of the patients of obesity as a health problem and their refusal to recognize that they have bad nutritional habits, health care pressure and lack of training. There is a feeling of frustration and that it is difficult to achieve and keep acceptable weight targets in their patients (AU)

Evaluación de la efectividad de un programa de seguimiento farmacoterapéutico en atención primaria sobre el control hematológico y calidad de vida en el paciente anticoagulado / No disponible

Objetivo: Evaluar los resultados de la intervención farmacéutica en un programa de seguimiento farmacoterapéutico de pacientes anticoagulados en el ámbito de la atención primaria.Metodología: Estudio prospectivo controlado de un año de duración. Se incluyen todos los pacientes anticoaguladosde 6 centros de salud que realicen control del coeficiente internacional normalizado y ajuste de dosisen el centro. Asignación de grupos por «emparejamiento». Variables dependientes: coeficiente internacionalnormalizado, problemas relacionados con los medicamentos y calidad de vida relacionada con la salud.Variables independientes: grupo exposición o control, edad, sexo, patologías, centro de salud. Se utilizará lametodología FARM para el seguimiento farmacoterapéutico; el análisis de problemas relacionados con losmedicamentos se hará según el Segundo Consenso de Granada y la evaluación del coeficiente internacionalnormalizado según los criterios del Comité Británico de Estándares en Hematología. Para análisis de lacalidad de vida relacionada con la salud, se empleará el cuestionario SF-36 mediante entrevistador independiente.Discusión: La principal limitación de este estudio es la imposibilidad de realizar asignación aleatoria depacientes para constituir los grupos de intervención y control. Respecto a la aplicabilidad, cabe destacar quelos resultados obtenidos en el estudio facilitarán tanto el conocimiento de los problemas relacionados con losmedicamentos y sus causas en este grupo de pacientes como los beneficios en salud obtenidos por los mismosy, por tanto, contribuirá a diseñar programas homogéneos y útiles de atención farmacéutica en los pacientesanticoagulados

Objective: To evaluate the results of pharmaceutical intervention in a Pharmacotherapeutic Follow-up programfor anticoagulated patients in the Primary Care setting.Methodology: A one-year controlled, prospective study. All the anticoagulated patients from six healthcenters being monitored according to the International Normalized Ratio and with dose adjustment attheir center are included. They will be assigned to groups by “pairing”. The dependent variables will be: theInternational Normalized Ratio, drug-related problems and health-related quality of life. The independentvariables will be: exposure or control group, age, sex, diseases and health center. The FARM methodology willbe utilized for pharmacotherapeutic follow-up; the analysis of drug-related problems will be done according to the Second Consensus of Granada, and the International Normalized Ratio will be evaluated according to the guidelines of the British Committee for Standards in Haematology. For the analysis of health-related quality of life, the SF-36 questionnaire, applied by an independent interviewer, will be employed.Discussion: The main limitation to this study is the impossibility of randomizing the assignment of thepatients to the intervention or control group. In terms of applicability, the results of the study will provideinformation concerning drug-related problems and their causes in this group of patients, as well as the healthbenefits obtained. Thus, they will contribute to the design of useful, standardized programs for pharmaceutical care in anticoagulated patients

Diseño y evaluación de un programa de seguimiento farmacoterapéutico a pacientes anticoagulados en atención primaria de salud / No disponible

La incorporación del farmacéutico a los equipos de atención primaria en Galicia supone la implementacióny desarrollo de programas de seguimiento farmacotera-péutico. El objetivo principal de este estudio fue diseñar y evaluar un programa de seguimiento farmacoterapéutico a pacientes anticoagulados; otros objetivos secundarios fueron los siguientes:1. Establecer y cuantificar indicadores de seguimiento.2. Registrar, cuantificar y clasificar los problemas relacionados con los medicamentos y resolución.3. Determinar y clasificar las causas que los originan.4. Determinar las demandas de información sobre anticoagulación oral de médicos y enfermeras.Se trata de un estudio longitudinal prospectivo de una sola cohorte, en el Centro de Saúde O Rosal (Pontevedra)durante 18 meses. Se incluyeron los 63 pacientes anticoagulados adscritos al centro que fueron derivadospor sus médicos de familia para inicio de seguimiento farmacoterapéutico. La evaluación del programase realizó mediante indicadores de cobertura, registro, proceso y resultado. El grado de cobertura alcanzadofue del 100%. Se realizaron 1.116 consultas (93,64% programadas), el 80,86% de las determinaciones de INRse encontraron en rango terapéutico. Se detectaron 327 PRM; el 10,7% causado por incumplimiento terapéuticoy el 27,2% por ajustes de dosis propios de la anticoagulación oral. Se aceptó el 97,81% de las intervenciones. Se resolvió el 95,10% de los problemas relacionados con medicamentos. El 63,83% de las consultasde información sobre anticoagulantes se relacionó con interacciones farmacológicas y el 36,17% con técnicaanalítica, indicación de nuevos tratamientos y ajuste de dosis entre otros. Se concluye que la incorporacióndel farmacéutico a los equipos de atención primaria promueve el desarrollo de programas de seguimientofarmacoterapéutico con buenos resultados y buena aceptación por los demás profesionales sanitarios

The inclusion of pharmacists in primary care teams in Galicia, Spain, enables the implementation anddevelopment of pharmacotherapeutic follow-up programs. The main objective of this study was to design andevaluate a pharmacotherapeutic follow-up program for anticoagulated patients. Other objectives included:1. Establishing and quantifying follow-up-related indicators.2. Recording, quantifying and classifying drug-related problems and their solution.3. Determining and classifying their causes.4. Determining the demands for information on oral anticoagulation on the part of physicians and nurses.A prospective, longitudinal study involving a single cohort was carried out at the Centro de Saúde O Rosalin Pontevedra, Spain. The 18-month study involved 63 anticoagulated patients referred to the center by theirfamily physicians to begin pharmacotherapeutic follow-up. The evaluation of the program was based onindicators related to coverage, registration, process and results. A coverage of 100% was achieved. There wasa total of 1116 patient visits (93.64% of them scheduled). The international normalized ratio determinations were within therapeutic range in 80.86% of cases. There were 327 drug-related problems; 10.7% of them were attributed to lack of compliance and 27.2% to adjustments of the doses of the oral anticoagulant. In all, 97.81% of the interventions were accepted and 95.10% of the drug-related problems were solved; 63.83% of the requests for information on anticoagulants were related to drug interactions and the remaining 36.17% tothe analytical method, indications for changes in treatment and dose adjustment, among others. The authorsconclude that the inclusion of pharmacists in primary care teams promotes the development of pharmacotherapeutic follow-up programs with good results, and that these programs are well accepted by other health care professionals (AU)

[Evaluation of a programme to monitor drug therapy in type-2 diabetics]. / Evaluación de un programa de seguimiento farmacoterapéutico a diabéticos tipo 2.

OBJECTIVES: To evaluate the results of pharmaceutical intervention in a programme to monitor the drug therapy of type-2 diabetics; and to assess the improvement of the indicators, glycosylated haemoglobin, basal glycaemia, lipid profile, albumin/creatinine, blood pressure, BMI, medication-related problems and adherence. DESIGN: Randomised clinical trial. SETTING: 14 local pharmacies in the province of Pontevedra (Galicia), Spain. SUBJECTS: 126 type-2 diabetics, over 18 years old and who joined voluntarily a monitoring programme, distributed 50-50 into intervention and control groups. VARIABLES: The main variable was HbA1c. Other variables were: clinical indicators of metabolic control (mean basal glycaemia, lipid profile), blood pressure, BMI, medication-related problems, understanding of the illness and its complications, adherence to medical treatment and to changes in life-style, and incidence of complications. METHODS: Introduction and randomisation of patients. Recording of the initial status of the research variables, study and assessment stage, pharmaceutical interventions to detect and resolve any passing medication-related problems and educational activities. Referral to family doctor if his/her intervention required. Follow-up lasted 12 months with monthly scheduled visits and on-demand visits, after which the variables were assessed once more. The stages of study, evaluation, intervention and education did not occur in the control group. DISCUSSION: The study will enable the role of the chemist in achieving the objectives of controlling type-2 diabetes patients to be achieved through educational intervention and assistance in drug therapy monitoring.

Calidad asistencial y evaluación de un programa de seguimiento farmacoterapéutico en anticoagulación oral por un equipo multidisciplinar de Atención Primaria de Salud / No disponible

Objetivo: Objetivo principal: evaluar un programa de terapia anticoagulante oral. Objetivos secundarios: determinar la prevalencia, aceptación por los pacientes, y grado de cobertura del control de anticoagulación oral por el equipo multidisciplinar con incorporación del farmacéutico de Atención Primaria. Cuantificar y clasificar los Problemas Relacionados con los Medicamentos y causas. Diseño: Estudio descriptivo transversal. Marco temporal: tres primeros meses de 2003. Emplazamiento: Unidad de Atención Primaria del Rosal (Pontevedra). Cobertura: 5.596 usuarios. Participantes: Se incluyeron los 49 pacientes adscritos al centro que recibían tratamiento con anticoagulantes orales. Criterio de exclusión: pacientes que no hubiesen realizado ningún control durante el período de estudio o que hubiesen rechazado el seguimiento farmacoterapéutico. Método: Se recogieron datos sobre características basales, indicaciones para terapia anticoagulante oral, Coeficiente internacional normalizado y Problemas Relacionados con Medicamentos. Determinación del Coeficiente internacional normalizado mediante técnica de química seca en sangre capilar. Se consideran rangos de referencia los establecidos por hospital de referencia. Análisis estadístico: las variables cuantitativas se expresaron como media±desviación estándar, variables cualitativas como frecuencias (porcentajes). Resultados: Prevalencia: 8,75 por mil. Grado de cobertura: 93,88%. El 63,6% de determinaciones en rango: INR=2,5±0,5 y 81,0% con INR=2,5±0,75. Se detectaron 53 PRM, 17% por medicamentos distintos a anticoagulantes orales. Causas: 32,07% por ajuste de dosis, 24,53% por interacción, 9,43% por incumplimiento y 5,66% por frecuencia o modo de administración inadecuado. Conclusiones: Adecuado control de terapia anticoagulante oral por el equipo multidisciplinar. Además de los anticoagulantes orales, otros medicamentos provocan Problemas Relacionados con los Medicamentos en proporción considerable (AU)

Objective: Main objective: to evalue therapeutic control of anticoagulant treatment. Secondary objective: to determine prevalence, acceptance by patients and control of oral anticoagulant treatment by the equipment with the incorporation of the primary care pharmacist. Cuantity and classify the drug related problems and their causes. Designe: Cross-sectional descriptive study. Three first months, 2003. Setting: O Rosal primary care center. Cover: 5596 users. Participants: 49 patients appointed to the center where they received the treatment were included. Patients who had not made any control during the period of the study or rejected the pharmaceutical care were exclused. Method: Data over patient baseline characteristics, indications for anticoagulant treatment and drug related problems. Determination of International Normalized Ratio (INR) by dry chemist in capillary blood. Referency ranks were considered the ones stablised by reference hospital. Statistic analysis: cuantitative variables were expressed as m±SD cualitative variables as frecuency (percentage). Results: Prevalence 8,75% per thousand. Cover degree: 93,88%. 63,6% of determinations in rank: INR=2,5±0,5 and 81,0% with INR=2,5±0,75. Were detected 53 drug related problems, 17 by drugs diferents to anticoagulant treatment. Cause: 32,07 by dosage adjustment, 24,53% by interaction, 9,43% by non compliance and 5,66% by frecuency or administration. Conclusions: Sustable control of anticoagulant treatment by the multidisciplinary equipment. Even anticoagulants other drugs cause drug related problems in a considerable frecuency (AU)

Evaluación de un programa de seguimiento farmacoterapéutico a diabéticos tipo 2 / Evaluation of a programme to monitor drug therapy in type-2 diabetics

Objetivos. Evaluar los resultados de la intervención farmacéutica en un programa de seguimiento farmacoterapéutico a pacientes diabéticos tipo 2. Valorar la mejoría de los indicadores: hemoglobina glucosilada (HbA1c) glucemia basal, perfil lipídico, albúmina/creatinina, presión arterial, índice de masa corporal, problemas relacionados con los medicamentos y adhesión al tratamiento. Diseño. Estudio experimental aleatorizado. Ámbito del estudio. Un total de 14 farmacias comunitarias de la provincia de Pontevedra (Galicia), España. Sujetos. Un total de 126 pacientes diabéticos tipo 2, mayores de 18 años, que entran voluntariamente en un programa de seguimiento, distribuidos al 50 por ciento en grupo intervención y grupo control. Variables. Variable principal: HbA1c. Otras variables: indicadores clínicos de control metabólico (glucemia basal media, perfil lipídico), presión arterial, índice de masa corporal, problemas relacionados con la medicación (PRM), conocimiento de la enfermedad y sus complicaciones, adhesión al tratamiento farmacológico y a las modificaciones de hábitos de vida e incidencia de complicaciones. Metodología. Incorporación y aleatorización del paciente. Registro del estado inicial de las variables de investigación, fase de estudio y evaluación, intervenciones farmacéuticas consistentes en la detección y resolución de eventuales PRM y acciones educativas (EpS). Remisión al médico de familia si se precisa su intervención. El seguimiento se realiza durante 12 meses en visitas mensuales programadas y visitas a demanda, al cabo de los cuales se efectúa una nueva evaluación de las variables. En el grupo control, las fases de estudio, evaluación, intervención y EpS, no se realizan. Discusión. El estudio permitirá ratificar el papel que el farmacéutico puede desempeñar en la consecución de los objetivos de control del paciente diabético tipo 2 mediante la intervención educativa y la colaboración en el seguimiento farmacoterapéutico (AU)

[National report on population and development]. / El informe nacional sobre poblacion y desarrollo.

PIP: This article is a three-page description of Peru's national report on population and development, submitted in October 1993 for the 1994 International Conference on Population and Development in Cairo. The report contains five sections and a statistical annex. The sections describe the demographic context of Peru and trends in the major variables, with projections for the future. The population policy is considered in the framework of development. The National Population Program for 1991-95 and its eight specific subprograms are described. The report also covers activities of the health sector, especially the family planning and reproductive health program, and three other programs in which actions have been undertaken: population education and communication, promotion of women, and research and diffusion. Information on the sources of funding is provided. Some US $52.1 million in external aid was supplied by the US and Japanese governments (47%), the UN system (21%), and international nongovernmental organizations. The report ends with a description of future population actions. The proposed goal is an annual growth rate of 0.94% by the year 2020, which would still mean an addition of 356,000 persons in that year. The proportion using contraception would need to increase to 75% from the current level of 59%, which includes a high proportion of poorly prepared users of periodic abstinence methods. Other goals are a 68% reduction in infant mortality to 20/1000, an increase in vaccination coverage of infants to 95%, and professional attendance at delivery for 90% of pregnant women.^ieng

[Proposal for the world action plan on population]. / La propuesta del plan de accion mundial sobre poblacion.

PIP: This article is a five-page description of the proposed Plan of Action of the International Conference on Population and Development, Cairo, September 1994, which was approved at the third preparatory conference in New York in April 1994. The basic feature of the Plan of Action is its respect for the unique conditions of each country. The document contains 16 chapters, including a preamble and a declaration of principles. The third chapter, on population, sustained economic growth, and sustainable development, stresses the need to alleviate poverty and improve living conditions. The fourth chapter urges an end to discrimination against women and recognition of the rights of girls. Other chapters contain recommendations regarding the family, population growth and structure, reproductive rights and family planning, morbidity and mortality, the need for better health care, population distribution and migration, and international migration. There are also chapters on population, education, and development; and technology, research, and development. The Plan recommends incorporating population issues into development plans and policies, fostering international cooperation, and collaborating with the nongovernmental sector.^ieng