Prescripción inducida en atención primaria de la Comarca Bilbao

ObjetivosPrincipales: conocer la proporción de prescripción inducida (PI) en Comarca Bilbao y su procedencia, la proporción de gasto correspondiente a la PI, la proporción de PI en los principales grupos terapéuticos, la actitud del médico de atención primaria ante la prescripción solicitada y su influencia en el gasto, la proporción de desacuerdo con dicha prescripción y los motivos de desacuerdo, y la proporción con informe del especialista. Secundarios: conocer la proporción de PI en los demás grupos terapéuticos, en fármacos VINE, EFG y en los de nula o baja mejora terapéutica.Diseño.Estudio transversal, descriptivoEmplazamientoAtención primariaParticipantesFármacos financiables prescritos por y/o solicitados a los médicos de familia de EAP.Resultados principalesSe estudiaron 7.922 fármacos. Tipo de prescripción: PI, 48,3% (IC del 95%, 47,2–49,4); del médico de atención primaria (PRO), 50,6% (IC del 95%, 49,5–51,7); desconocida, 1,1% (IC del 95%, 0,9–1,3). Procedencia principal: especialista público (72,2%), especialista privado (16,6%). Un 62,5% del gasto correspondió a la PI. En el grupo terapéutico más prescrito, sistema nervioso central (24,2%), PI, 39,8%; PRO, 58,9%; en aparato cardiovascular (19,1%), PI, 56,2%, PRO, 43,1%. Se prescribió el fármaco solicitado en un 98,4% de los casos, se cambio en el 1,2% y se suprimió en un 0,4%. Proporción de desacuerdo, 11%; motivos de desacuerdo, no hay necesidad de tratar (23,9%), grupo terapéutico (34,4%), principio activo (13,2%), marca comercial (28,5%). Hubo informe de especialista en un 62,4% de los casos.ConclusionesSe detecta una proporción considerable de prescripción no atribuible a atención primaria y una proporción importante de fármacos que el médico de primaria prescribe sin estar de acuerdo. Sería necesario un sistema que permitiera separar el gasto por niveles, así como mejorar la comunicación entre éstos.ObjectivesMain objetives: to know the proportion of induced prescription (IP) in Area Bilbao and its source, the proportion of cost IP accounts for, the proportion of IP in the main therapeutic groups, the attitude of GP when requested for prescription and its influence on cost, the proportion of disagreement with requested prescription, the reasons for disagreement, and the proportion with letter from specialist. Secondary objectives: to know the proportion of IP in the remaining therapeutic groups, in drugs of low clinical value, in generic drugs and in new drugs with low or no therapeutic improvement.DesignA descriptive cross-sectional study.SettingPrimary health care.ParticipantsDrugs prescribable under National Health Service prescribed by and/or requested to GPs.Main results7.922 drugs were analysed. Type of prescription: IP, 48.3% (95% CI, 47.2–49.4); GP prescription (GPP), 50.6% (95% CI, 49.5–51.7); unknown source, 1,1% (95% CI, 0.9–1.3). Main source, public specialist (72.2%), private specialist (16.6%). IP accounted for 62.5% of cost. In the most prescribed therapeutic group, central nervous system (24.2%), IP, 39.8%; GPP, 58.9%; in cardiovascular system (19.1%), IP, 56.2%; GPP, 43.1%. 98.4% of requested prescription was actually prescribed, 1.2% was changed and 0.4%, suppressed. Proportion of disagreement, 11%; reasons for disagreement, no need for medical treatment (23.9%), therapeutic group (34.4%), active ingredient (13.2%), brand name (28.5%). There was a 62.4% with letter from specialist.ConclusionsPrimary care is not accountable for a substantial proportion of prescription. GP prescribes a considerable proportion of drugs without agreement. It would be necessary a system that allows to separate the cost by care levels and also improve their communication

Prenatal air pollution exposure and growth and cardio-metabolic risk in preschoolers

Objectives: We investigated the association between outdoor air pollutants exposure in the first trimester of pregnancy, and growth and cardio-metabolic risk at four years of age, and evaluated the mediating role of birth weight. Methods: We included mother-child pairs (N = 1,724) from the Spanish INMA birth cohort established in 2003–2008. First trimester of pregnancy nitrogen dioxide (NO2) and fine particles (PM2.5) exposure levels were estimated. Height, weight, waist circumference, blood pressure, and lipids were measured at four years of age. Body mass index (BMI) trajectories from birth to four years were identified. Results: Increased PM2.5 exposure in the first trimester of pregnancy was associated with decreased z-scores of weight (zWeight) and BMI (zBMI) (zWeight change per interquartile range increase in PM2.5 exposure = −0.12; 95% CI: −0.23, −0.01; zBMI change = −0.12; 95% CI: −0.23, −0.01). Higher NO2 and PM2.5 exposure was associated to a reduced risk of being in a trajectory with accelerated BMI gain, compared to children with the average trajectory. Birth weight partially mediated the association between PM2.5 and zWeight and zBMI. PM2.5 and NO2 were not associated with the other cardio-metabolic risk factors. Conclusions: This comprehensive study of many growth and cardio-metabolic risk related outcomes suggests that air pollution exposure during pregnancy may be associated with delays in physical growth in the early years after birth. These findings imply that pregnancy exposure to air pollutants has a lasting effect on growth after birth and require follow-up at later child ages.This study was funded by grants from the Eulji University (grant numbers ESCAPE project FP7-ENV-2007-1-211250, DENAMIC project FP7-ENV-2011-282957, HELIX project FP7-ENV-2012-308333, and MEDALL project HEALTH.2010.2.4.5-1), from the Spanish Instituto de Salud Carlos III (grant numbers Red INMA G03/176; CB06/02/0041; PI03/1615 incl. FEDER funds, PI04/1112 incl. FEDER funds, PI041436, PI04/1509 incl. FEDER funds, PI04/1931 incl. FEDER funds, PI042018 incl. FEDER funds, PI05/1079 incl. FEDER funds, PI05/1052 incl. FEDER funds, FIS-PI06/0867, PI06/1213 incl. FEDER funds, PI07/0314 incl. FEDER funds, PI081151 incl. FEDER funds, FIS-PI09/00090, PI09/02311 incl. FEDER funds, PI09/02647 incl. FEDER funds, PI11/01007 incl. FEDER funds, PI11/02591 incl. FEDER funds, PI11/02038 incl. FEDER funds, PI13/1944 incl. FEDER funds, PI13/2032 incl. FEDER funds, PI13/02429 incl. FEDER funds, PI14/00891 incl. FEDER funds, PI14/01687 incl. FEDER funds, PI15/00118 incl. FEDER funds, PI16/1288 incl. FEDER funds, and PI17/00663 incl. FEDER funds, PI18/00547 incl. FEDER funds, PI18/00909 incl. FEDER funds; CP11/00178 , CP15/00025, and CPII16/00051; MS13/00054 incl. FEDER funds), CIBERESP, Department of Health of the Basque Government (grant numbers 2005111093, 2013111089), Generalitat de Catalunya-CIRIT (grant numbers 1999SGR 00241), Generalitat Valenciana: FISABIO (grant numbers UGP 15-230, UGP-15-244, and UGP-15-249), Provincial Government of Gipuzkoa (grant number DFG06/002), Alicia Koplowitz Foundation 2017, Fundació La marató de TV3 (grant number 090430), Obra Social Cajastur/Fundación Liberbank, Universidad de Oviedo, and annual agreements with the municipalities of the study area of the Gipuzkoa sub-cohort (Zumarraga, Urretxu , Legazpi, Azkoitia, Azpeitia and Beasain). ISGlobal is a member of the Agency for the Research Centres of Catalonia (CERCA) Programme, Generalitat de Catalunya

Temporal Distribution and Weather Correlates of Norway Rat (Rattus norvegicus) Infestations in the City of Madrid, Spain

Urban Norway rats are challenging pests, posing significant health and economic threats. Implementing ecologically based integrated rodent management (EBIRM) programmes relies primarily on the understanding of ecological relationships between rodents and their environments, with emphasis on the processes influencing rodent populations in the target ecosystem. We investigated the temporal distribution of urban Norway rat infestations in Madrid, Spain, and tested for the association of such infestations with temperature, relative humidity and precipitation by fitting a multivariate Poisson generalized linear model to a 3-year (2006–2008) daily time series of 4,689 Norway rat sightings. Norway rat infestations showed a marked seasonality, peaking in the summer. Most Norway rat sightings were reported on Mondays. Minimum temperature and relative humidity were positively associated with Norway rat infestation, whereas the association with precipitation was negative. The time series was adequately explained by the model. We identified previously unrecognized time periods that are more prone to Norway rat infestation than others and generated hypotheses about the association between weather, human outdoor activity, resource availability, rodent activity and population size. This provided local authorities engaged in preserving urban ecosystem health with basic research information to predict future rodent outbreaks and support the implementation of EBIRM programmes in urban areas

Genetic analyses of aplastic anemia and idiopathic pulmonary fibrosis patients with short telomeres, possible implication of DNA-repair genes

Altres ajuts: Funded by one ACCI project from CIBERER and one grant to the FPI cohort from CIBERES.Background: Telomeres are nucleoprotein structures present at the terminal region of the chromosomes. Mutations in genes coding for proteins involved in telomere maintenance are causative of a number of disorders known as telomeropathies. The genetic origin of these diseases is heterogeneous and has not been determined for a significant proportion of patients. Methods: This article describes the genetic characterization of a cohort of patients. Telomere length was determined by Southern blot and quantitative PCR. Nucleotide variants were analyzed either by high-resolution melting analysis and Sanger sequencing of selected exons or by massive sequencing of a panel of genes. Results: Forty-seven patients with telomere length below the 10% of normal population, affected with three telomeropathies: dyskeratosis congenita (4), aplastic anemia (22) or pulmonary fibrosis (21) were analyzed. Eighteen of these patients presented known pathogenic or novel possibly pathogenic variants in the telomere-related genes TERT, TERC, RTEL1, CTC1 and ACD. In addition, the analyses of a panel of 188 genes related to haematological disorders indicated that a relevant proportion of the patients (up to 35%) presented rare variants in genes related to DNA repair or in genes coding for proteins involved in the resolution of complex DNA structures, that participate in telomere replication. Mutations in some of these genes are causative of several syndromes previously associated to telomere shortening. Conclusion: Novel variants in telomere, DNA repair and replication genes are described that might indicate the contribution of variants in these genes to the development of telomeropathies. Patients carrying variants in telomere-related genes presented worse evolution after diagnosis than the rest of patients analyzed