[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.

Decreasing but still high levels of halogenated flame retardants in wetland birds in central Spain.

The occurrence of classical and emerging halogenated flame retardants in bird samples collected between 2010-17 from the Castrejón reservoir (central Spain) was studied. Different wetland bird samples were analysed, including unhatched bird eggs and liver of dead nestlings. Polybrominated diphenylethers (PBDEs) were detected in all the samples at high concentration values, with levels up to 5167 ng/g lw. Dechloranes were found in 78% of analysed samples, but at lower concentration levels, between not detected (nd) and 2153 ng/g lw. The time trend evaluation over the sampling period showed an approximately 50% decline in mean concentrations of PBDEs. However, the most recent data for PBDEs (2016-17) still indicate that, in some cases, and based on reported LOECs, wetland birds were exposed to PBDE concentrations that are associated with possible ecological hazards.

Cambios percibidos por personas con diversidad funcional motora adquirida en sus vidas cotidianas tras la obtención de perros de servicio / Changes perceived by people with acquired motor functional diversity in their daily lives after obtainment service dogs

El presente estudio surge del interés por analizar los cambios percibidos por personas con diversidad funcional motora adquirida en sus vidas cotidianas tras la adquisición de perros de servicio. La revisión de investigaciones internacionales sobre efectividad de la tenencia de estos animales, así como la revisión de las teorías del vínculo y de la biofilia proporcionan un primer acercamiento para comprender los posibles cambios. A partir de todo ello surge la pregunta: ¿Cómo perciben los cambios en sus vidas cotidianas las personas en estudio tras la obtención de perros de servicio otorgado por la corporación Bocalán Confiar? El estudio se visualiza desde el paradigma interpretativo y contempla la revisión teórica y fuentes directas a través de entrevistas semi-estructuradas, mediante las cuales se obtuvo una perspectiva personal acerca de la situación. Se analizaron los cambios desde nueve categorías: Actividades de la vida diaria, trabajo remunerado, tiempo libre, relaciones interpersonales, familia, accesibilidad, responsabilidad, seguridad y vínculo. Los hallazgos dejan en evidencia que la obtención del perro de servicio no sólo influye en independencia funcional, sino también en el ámbito emocional, social y familiar...

This study arises from the interest in analyzing the changes perceived by people with motor functional diversity acquired in their daily lives following the acquisition of service dogs. The revision of international research on effectiveness of tenure of these animals, as well as the revision of the theories on bonding and biophilia provides insight to understand the possible changes. From all this, the question arises: How do the people under study perceive the changes in their daily lives after obtaining service dogs by Bocalán Confiar Corporation? The study is visualized from the interpretive paradigm and provides the theoretical review and direct sources through semistructured interviews, by means of which a personal perspective on the situation was obtained. Changes were analyzed from nine categories: activities of daily living, paid work, free time, relationships, family, accessibility, accountability, security and link. Findings evidence that the obtainment of the service dog does not only influences functional independence, but also in the emotional, social and family field...

Gender and viability selection on morphology in fledgling pied flycatchers.

Until recently, analyses of gender-dependent differences in viability selection and the ontogeny of sexual size dimorphism have been plagued by difficulties in determining the sex of nestling birds on the basis of morphology. Recently, this problem was overcome using molecular sex identification to report for the first time body-size-mediated antagonistic selection on the viability of male and female collared flycatchers. We used molecular sex identification to analyse natural selection on fledgling viability, sexual size dimorphism and effects of parasites in relation to gender in a Mediterranean population of the related pied flycatcher Ficedula hypoleuca. There was directional positive selection on fledgling weight but no selection on tarsus length. Fledgling weight was the most important determinant of fledgling survival, with heavier fledglings having increased viability. Although selective trends were of the same sign for both sexes, only among female fledglings were selection differentials and gradients statistically significant. Therefore, similar trends in selection were revealed in analyses of a data set where sex was ignored and in separate analyses using same-sex sibship trait means. Mite nest ectoparasites negatively affected fledgling weight, and the effects were stronger in female than male fledglings. There was no effect of parasitism on the tarsus length in males, as previously reported in retrospective analyses performed without knowledge of sex until recruitment. Overall, selection on fledgling viability on the basis of morphological traits and hatching date was not confounded by an individual's gender.

[Acquired pneumonias in the community of Andoain]. / Neumonías adquiridas en la comunidad de Andoain.

OBJECTIVE: To discover the clinical-epidemiological characteristics of pneumonias in our community. DESIGN: Descriptive study. SETTING: Andoain Health Centre. PATIENTS AND OTHERS PARTICIPANTS: There were 8,862 people in the reference population. All the cases of acquired pneumonia in the community were recorded. This register included those diagnosed in the Health Centre and in Casualty Departments and hospitals where patients were referred, between June 1 1991 and September 30 1992. The inclusion criteria were: acute fever chart and/or acute respiratory infection accompanied by a radiological image of pneumonic condensation. INTERVENTIONS: The model treatment was 500 mg of Erythromycin at six-hourly intervals for 14 days. 500 mg of Cefuroxim every twelve hours was added in cases considered at risk. MEASUREMENTS AND MAIN RESULTS: A total of 97 pneumonias were recorded, which represented an incidence of 8.82 pneumonias per thousand inhabitants per year. 63% were male. The average age was 42 (SD 19.25). 83% were diagnosed at the Health Centre. One-third presented a recent viral infection. Half had some risk factor: tobacco use was the most common. Response to treatment was satisfactory. Five percent had some complication. No death was recorded. CONCLUSIONS: Pneumonia is a frequent cause of attendance at Primary Care centres. There are several clear clinical symptoms, a good response to treatment with Erythromycin and virtual absence of complications [corrected].