[Evaluation of the collaboration between Primary and Hospital Care in order to improve inappropriate prescription]. / Evaluación de la colaboración entre atención primaria y hospitalaria para mejorar la polimedicación inapropiada.

INTRODUCTION AND OBJECTIVES: To evaluate the implementation of a collaborative experience between Primary (PC) and Hospital Care (HC) aimed at reducing potentially inappropriate prescribing (PIP) in patients with polypharmacy. MATERIALS AND METHODS: Collaborative experience including a controlled before-after intervention study, carried out in the Donostialdea Integrated Health Organization (IHO), with Bilbao Basurto IHO as control group, Osakidetza, Basque Health Service. Participant were 227 PC physicians and physicians from 7 hospital services, and patients with 5 or more drugs meeting at least one PIP criteria. The intervention consisted of communication and knowledge between professionals, PC-HC consensus, training, identification of patients at risk, medication review, evaluation and feed-back. The collaboration process (agreements, consensus documents, training activities) and the change in the prevalence of PIP in polymedicated patients (using computerised health records) were evaluated. RESULTS: A total of 21 PIP criteria and 6 recommendation documents were agreed. An analysis was performed on 15,570 PIP from OSI Donostialdea and 24,866 from the control group. The prevalence of PIP in polymedicated patients was reduced by -4.53% (95% CI: -4.71 to -4.36, P< .0001) in comparison with the control group. The before-after differences were statistically significant across the 7 services. CONCLUSIONS: PC-HC collaboration is feasible and, along with other intervention components, reduces inappropriate polypharmacy in the context of a recently integrated healthcare organisation. The collaboration process is complex and requires continuous monitoring, policy involvement, leadership that encourages health professional participation, and intensive use of information systems.

[Genetic demographic study of Zulia State, Venezuela, by isonymy]. / Estudio genético demográfico del Estado Zulia, Venezuela, a través de isonimia.

The genetic structure of Zulia State, Venezuela, was studied through the distribution of surnames from individuals above 40 years of age, obtained from the register of electors. The sample studied consisted in 440, 190 individuals and 10,423 different surnames. For each of the 81 counties of the State, the following estimators were calculated: percentage of the population included in surnames which appear only once (estimator A), percentage of the population included in the seven most frequent surnames (estimator B), the coefficient of consanguinity due to random isonymy phi ii, and Karlin and McGregort's ni (v), an estimator of migration. The correlation between phi ii and B was 0.92, indicating that 85% of the variation observed in the coefficient of consanguinity due to random isonymy is due to the seven most frequent surnames. The correlation between A and ni was 0.93, so that 86% of the variation observed in ni, is due to surnames which appear only once. On the other hand, correlations between A and B, and between phi ii and v were non significant (-0.08 and -0.17 respectively), meaning that they are measuring different features of population structure: B and phi ii, isolation, while A and v, migration. The most isolated counties of Zulia are localized towards the northwestern portion of the State, within the Venezuelan Guajira, although relative isolation is also observed in the southern counties. Isolation by distance is estimated through the correlation between the logarithmic transformations of Euclidean and geographic distances, giving a value of 0.63. This high value might be partially due to the barrier effect of the Lake of Maracaibo. Eight surnames with a focal distribution within Zulia were identified: Almarza, Badell, Bastidas, Bohórquez, Cardozo, Carmona, Espina and Matos. Carriers of these surnames have a high probability of having their origin at the counties where they are localized.

[Testosterone metabolism in isolated cells of rat and ram seminiferous tubules]. / Métabolisme de la testostérone dans les cellules isolées du tube séminifère de rat et de bélier

Aspermatogenic seminiferous tubules were obtained from adult Wistar rats treated with Busulfan at the 20th day of foetel life. The isolated tubules converted 14C testosterone (T) into androstenedione (delta4), 3,5%) 5 alpha-dihydrotestosterone (DHT), (1%) ANd 5 alpha-androstane-3 beta, 17 beta-diol at unit gravity and incubated with 14C-T. Only delta was produced (2%). Using a similar technique the same result was obtained when pure preparation of round spermatids and primary spermatocytes from ram testis were incubated with 14C-T. From these experiments, we conclude that 5 alpha-reductase activity is present only in Sertoli cells.