Transcriptomic basis of sex loss in the pea aphid.

BACKGROUND: Transitions from sexual to asexual reproduction are common in eukaryotes, but the underlying mechanisms remain poorly known. The pea aphid-Acyrthosiphon pisum-exhibits reproductive polymorphism, with cyclical parthenogenetic and obligate parthenogenetic lineages, offering an opportunity to decipher the genetic basis of sex loss. Previous work on this species identified a single 840 kb region controlling reproductive polymorphism and carrying 32 genes. With the aim of identifying the gene(s) responsible for sex loss and the resulting consequences on the genetic programs controlling sexual or asexual embryogenesis, we compared the transcriptomic response to photoperiod shortening-the main sex-inducing cue-of a sexual and an obligate asexual lineage of the pea aphid, focusing on heads (where the photoperiodic cue is detected) and embryos (the final target of the cue). RESULTS: Our analyses revealed that four genes (one expressed in the head, and three in the embryos) of the region responded differently to photoperiod in the two lineages. We also found that the downstream genetic programs expressed during embryonic development of a future sexual female encompass ∼1600 genes, among which miRNAs, piRNAs and histone modification pathways are overrepresented. These genes mainly co-localize in two genomic regions enriched in transposable elements (TEs). CONCLUSIONS: Our results suggest that the causal polymorphism(s) in the 840 kb region somehow impair downstream epigenetic and post-transcriptional regulations in obligate asexual lineages, thereby sustaining asexual reproduction.

[Night workers' exposure to harshness factors in France: Lessons learned from the 2010 SUMER Survey]. / L'exposition des travailleurs de nuit aux facteurs de pénibilité en France : les enseignements de l'enquête SUMER 2010.

BACKGROUND: Despite the fact that French laws state that night work should be exceptional, the number of night workers has sharply increased in the past 20 years. At the same time, empirical and epidemiological studies indicate that night work has negative effects on workers' health. This is why the 2010 French pension act considered night work to be a drudgery. The aim of this study is to investigate whether night workers are more subject to other factors defined as contributing to the drudgery of work than are day workers. This article focuses on exposure to physical constraints (manual manipulation of heavy loads, awkward posture, exposure to mechanical vibrations) and aggressive physical environment (carcinogenic, mutagenic and reprotoxic chemicals [CMR], extreme temperature and noise). METHODS: Our study used the 2010 Medical Monitoring Survey of Occupational Risks [Surveillance médicale des expositions aux risques professionnels, (SUMER)] that was conducted among a sample of around 50,000 employees representative of 21.7 million French employees. We used logistic regressions to explore the potential influence of night work on the probabilities of exposure to at least one CMR, noise, thermal nuisance and physical constraints. RESULTS: Even though descriptive statistics suggest that night workers are more exposed to drudgery of work than day workers, our multivariate logistic models indicate that the exposure is not always positively correlated with the number of nights worked. Moreover, the exposure differs according to gender and socio-occupational category. CONCLUSION: Our findings suggest that night workers are more exposed to several factors defined as contributing to the drudgery of work than are day workers. Thus, they seem to face multiple disadvantages in the labor market. Preventive measures in favor of night workers should be targeted at job content as much as work organization.

From guidelines to current practices: Suboptimal hypertension management in France.

In France, the prevalence of hypertension is higher than 30%. Although treatment guidelines have been well established over the last twenty years, the national blood pressure control rate is below the average of high-income countries. This observational study aimed to describe the antihypertensive prescription behaviours of primary care physicians (PCPs) in France and to assess their compliance with current French guidelines, focusing on three specific prescription issues and their potential repercussions on blood pressure control: treatment initiation, treatment renewal or change and type of triple therapy. Prescription data were retrieved using the IQVIA longitudinal patient database (LPD), which delivers real-world data insights from French primary care electronic medical records (EMR). The average number of prescribed therapeutic agents was 1.9 per patient, with 39.3% monotherapy prescriptions. Treatment initiation represented 7.2% of all antihypertensive prescriptions. At treatment initiation, 22.5% of patients were prescribed dual therapy. The proportion of treatment renewal in the same therapeutic class was 74.3% while the proportion of treatment change was 18.5%. Of these, only 6.3% of patients received an additional therapy. Lastly, 35.7% of triple therapies were consistent with the recommended combinations. In conclusion, this study provides evidence of therapeutic gaps in hypertension management in France. The low blood control rate may be attributed to PCPs' therapeutic inertia and lack of knowledge of treatment guidelines. All stakeholders should commit to rapid corrective action in order to provide patients with the best care.

[Burnout syndrome in health professionals at a university hospital in Spain]. / Síndrome de Burnout en profesionales sanitarios en un hospital universitario de España.

OBJECTIVE: To evaluate the risk of Burnout in the health professionals of the Huesca University Hospital, 50 years after its inauguration, to investigate the variables related to the work motivation of the hospital health personnel and to assess the predisposing and protective factors of the risk of Burnout. MATERIAL AND METHODS: An observational, analytical, prospective and unicentric study was conducted from September 2017 to April 2019, evaluating all the health professionals who worked at the Hospital San Jorge de Huesca (n=209). RESULTS: The mean age was 42.86 years. 72.2% were women. 12.4% had moderate risk of burnout. There was 12.4% of high emotional exhaustion, 36.8% of high depersonalization and 44.5% of low personal accomplishment. Burnout was statistically significant associated with the professional category (P=.010), work experience (P=.026), hours of work per week (P=.036), choice of the same profession (P=.001) and recommendation to the offspring (P<.001). CONCLUSIONS: One tenth of the sample had a moderate risk of burnout. Almost half of the health workers confirmed a high degree of satisfaction with the work environment and the majority expressed an adequate use of well-being strategies and a high degree of autonomy, recognition and satisfaction at work.

Realistic simulation of cardiac magnetic resonance studies modeling anatomical variability, trabeculae, and papillary muscles.

Simulated magnetic resonance imaging brain studies have been generated for over a decade. Despite their useful potential, simulated cardiac studies are only emerging. This article focuses on the realistic simulation of cardiac magnetic resonance imaging datasets. The methodology is based on the XCAT phantom, which is modified to increase realism of the simulated images. Modifications include the modeling of trabeculae and papillary muscles based on clinical measurements and published data. To develop and evaluate our approach, the clinical database included 40 patients for anatomical measurements, 10 patients for papillary muscle modeling, and 10 patients for local gray value statistics. The virtual database consisted of 40 digital voxel phantoms. Histograms from different tissues were obtained from the real datasets and compared with histograms of the simulated datasets with the Chi-square dissimilarity metric (χ(2)) and Kullback-Leibler divergence. For the original phantom, χ(2) values averaged 0.65 ± 0.06 and Kullboek-Leibler values averaged 0.69 ± 0.38. For the modified phantom, χ(2) values averaged 0.34 ± 0.12 and Kullboek-Leibler values averaged 0.32 ± 0.15. The proposed approach demonstrated a noticeable improvement of the local appearance of the simulated images with respect to the ones obtained originally.

Efficacy of extended infusion of ß-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients: protocol for a randomised, multicentre, open-label, superiority clinical trial (BEATLE).

BACKGROUND: Febrile neutropaenia (FN) is a very common complication in patients with haematological malignancies and is associated with considerable morbidity and mortality. Broad-spectrum antipseudomonal ß-lactam antibiotics (BLA) are routinely used for the treatment of cancer patients with FN. However, the clinical efficacy of BLA may be diminished in these patients because they present with pathophysiological variations that compromise the pharmacokinetic (PK) parameters of these antibiotics. Optimised administration of BLA in prolonged infusions has demonstrated better clinical outcomes in critically ill patients. However, there is a paucity of data on the usefulness of this strategy in patients with FN. The aim of this study is to test the hypothesis that the administration of BLA would be clinically more effective by extended infusion (EI) than by intermittent infusion (II) in haematological patients with FN. METHODS: A randomised, multicentre, open-label, superiority clinical trial will be performed. Patients with haematological malignancies undergoing chemotherapy or haematopoietic stem-cell transplant and who have FN and receive empirical antibiotic therapy with cefepime, piperacillin-tazobactam or meropenem will be randomised (1:1) to receive the antibiotic by EI (during half the time of the dosing interval) in the study group, or by II (30 min) in the control group. The primary endpoint will be clinical efficacy, defined as defervescence without modifying the antibiotic treatment administered within the first 5 days of therapy. The primary endpoint will be analysed in the intention-to-treat population. The secondary endpoints will be pharmacokinetic/pharmacodynamic (PK/PD) target achievement, bacteraemia clearance, decrease in C-reactive protein, overall (30-day) case-fatality rate, adverse events and development of a population PK model of the BLA studied. DISCUSSION: Data on the usefulness of BLA administration in patients with FN are scant. Only three clinical studies addressing this issue have been published thus far, with contradictory results. Moreover, these studies had some methodological flaws that limit the interpretation of their findings. If this randomised, multicentre, phase IV, open-label, superiority clinical trial validates the hypothesis that the administration of BLA is clinically more effective by EI than by II in haematological patients with FN, then the daily routine management of these high-risk patients could be changed to improve their outcomes. TRIAL REGISTRATION: European Clinical Trials Database: EudraCT 2018-001476-37. ClinicalTrials.gov, ID: NCT04233996.

[Task delegation in primary care: new roles to the nursing personnel in Catalunya]. / La delegation de taches en soins primaires: les nouveaux roles des infirmieres en Catalogne.

A model of provision of primary care is experimented in a Catalan health centre. The model implies more varied roles and greater autonomy to nurses. They are the first contact of the patients coming to the health center. They base their decisions on a Guide for interventions on emergencies. The latter are distributed into 3 groups: (i) the cases which can be dealt with and finalized by the misusing the protocols previously established; (ii) the cases which require immediate care from the nurse, later intervention from the physician and common finalization at the end; (iii) the cases which require immediate intervention from the physician and, if the physician is not available, an evaluation from the nurse in the meanwhile. On 202 patients requesting a consultation on the same day, the data below are obtained:--70% cases have been resolved by the nurse using the Guide--14% cases have been resolved by the nurse after a telephone conversation with the physician--16% have been orientated to the relevant departments. Moreover, the on duty physician has been consulted in 6% The Guide appears therefore extremely useful. However, in the long range, the need for additional training in some specific domains were emerging, and that of constant interchange between physicians and nurses as well.

[Acalculous cholecystitis: an uncommon form of presentation of Q fever]. / Colecistitis alitiásica: una forma infrecuente de presentación de fiebre Q.

Acute acalculous cholecystitis is a very rare clinical presentation of Q fever. We report the case of a 38-year-old man who presented with fever associated with elevation of liver enzyme levels and thickening of the gallbladder wall on abdominal ultrasonography and who was initially diagnosed with acute acalculous cholecystitis. Due to the persistence of fever and transaminase elevation despite antibiotic treatment, a liver biopsy was performed. Characteristic "doughnut" epithelioid granulomas were observed, suggesting a diagnosis of granulomatous hepatitis caused by Q fever, which was confirmed by serological methods. Treatment with doxycycline was commenced and the patient subsequently showed rapid clinical improvement, with disappearance of fever and normalization of liver enzyme levels. We review 8 cases of acute cholecystitis associated with Q fever published in the literature and stress the importance of liver biopsy in the etiological diagnosis of patients with prolonged fever and abnormal liver function tests.

Unprecedented oxidation of a phenylglycinol-derived 2-pyridone: enantioselective synthesis of polyhydroxypiperidines.

[reaction: see text]. The phenylglycinol-derived 2-pyridone 1 undergoes m-CPBA oxidation steroselectively leading to the chiral nonracemic unsaturated bicyclic hydroxylactam 2, from which the enantioselective synthesis of (3R,5R)-3,4,5-trihydroxypiperidine (16) and the formal synthesis of the azasugar epiisofagomine are described. The enantioselective synthesis of (S)-N-Boc-3-hydroxypiperidine and (3R,4S)-3,4-dihydroxypiperidine is also reported.

Virus isolation, polymerase chain reaction and in vitro antibody production for the diagnosis of pediatric human immunodeficiency virus infection.

Viral culture (VC), polymerase chain reaction (PCR) and in vitro antibody production (IVAP) by peripheral blood mononuclear cells were compared for the early diagnosis of HIV-1 infection in 46 infants born to HIV-1 seropositive mothers. The ten children considered infected on the basis of clinical signs and persistence of anti-HIV-1 antibodies had at least one positive viral culture and seven were always positive in both PCR and IVAP tests. PCR and IVAP tests were occasionally negative in three infected children. Among 30 healthy children who became seronegative and were always negative for viral culture, 22 (73.3%) were also repeatedly negative in PCR and IVAP. We report 6 cases of children classified as P2A at the term of this study but who had lost anti-HIV-1 antibodies. They presented at least one positive viral culture and occasional positive PCR and/or IVAP results. The results indicate that the combination of viral culture, PCR and IVAP tests improves the early diagnosis of pediatric HIV infection.

Improvement of exercise-induced ischaemia and myocardial perfusion after aminophylline.

BACKGROUND: Previous studies have suggested that aminophylline improves exercise-induced ischaemia by preventing the redistribution of the coronary flow from ischaemic to non-ischaemic myocardium. The purpose of the study was to assess whether aminophylline improves myocardial perfusion in zones supplied by collateral circulation. METHODS: Twenty-three patients with an occluded coronary artery and collateral circulation from a non-diseased vessel underwent two symptom-limited exercise 99mTc-MIBI, single-photon emission computed tomography (SPECT) myocardial scintigraphy experiments, which were preceded by an intravenous infusion of either aminophylline (5 mg/kg over 20 min) or saline solution in a randomized double-blind control procedure. The MIBI SPECT images were analysed by two experienced observers who were blinded to each other's data. RESULTS: All patients underwent cardiac catheterization. For 16 patients this was because of stable angina and the remaining eight were post-myocardial infarction patients with a positive exercise test. Aminophylline significantly increased the time to the onset of ischaemia in the 15 patients with a positive exercise test (mean +/- SD, 6.5 +/- 1.9 compared with 5.3 +/- 1.8 min, P < 0.005); and ischaemia occurred at higher rate-pressure product (230 +/- 68 compared with 195 +/- 68 HB x mmHg, P < 0.03). After aminophylline, exercise ST-segment depression was 1.1 +/- 0.5 mV, compared with 1.5 +/- 0.8 mV after placebo (P < 0.01). All patients had perfusion defects that resolved partially or completely in the rest images. The imaging score was significantly lower after aminophylline infusion than after placebo (9.7 +/- 9 compared with 12.1 +/- 10, P < 0.01). CONCLUSIONS: Aminophylline significantly delayed the time to onset of exercise-induced ischaemia and improved perfusion in zones supplied by collateral circulation. Aminophylline-like drugs may be useful in the treatment of selected patients with ischaemic heart disease.

Myocardial uptake of antimyosin antibody in idiopathic dilated cardiomyopathy and its relation to functional and morphological parameters.

Monoclonal 111In antimyosin (AMS) uptake indicates the presence of ongoing myocyte damage. In idiopathic dilated cardiomyopathy (IDC), there is diffuse myocyte damage. We have attempted to find a correlation between AMS uptake and functional myocardial parameters. With this purpose in mind, we studied two groups of subjects: group 1 comprised 19 subjects with IDC and group 2 comprised 6 control subjects. In all subjects, an antimyosin scan was performed. Among the subjects with IDC, two-dimensional echocardiography was carried out to determine the left ventricular ejection fraction (LVEF) and left ventricular dimensions, and a gated blood pool study was undertaken to assess the LVEF at rest and end-diastolic and end-systolic volumes. Three months later, repeat antimyosin scintigraphy and equilibrium gated blood pool were performed on 13 of the patients. The mean heart to lung (H/L) ratio in the IDC subjects was 1.82 +/- 0.25 (range 1.42-2.25), a value significantly higher than that obtained in the controls: 1.41 +/- 0.12 (range 1.26-1.58) (P < 0.001). Linear regression analysis did not find a statistically significant correlation between H/L and gated blood pool or echocardiography measures. No marked changes in ejection fraction and antimyosin uptake were found between baseline and follow-up studies. Subjects with IDC have a high incidence of positive antimyosin scans, but antimyosin uptake is not related to any functional or morphological parameters.

Eutectic mixture of local anesthetics in adult urology patients: an observational trial.

BACKGROUND AND OBJECTIVES: The effectiveness of EMLA eutectic mixture of local anesthetics, (ASTRA Co, France) cream in minor surgery on the penis and its acceptability in unpremedicated outpatients were assessed. METHODS: EMLA cream was applied 1 hour before surgery (fremulum plasty, circumcision or dorsal section for phimosis, and condyloma accuminatum) in addition to a subcutaneous infiltration of lidocaine 1%, just before incision in cases of circumcision. Verbal Rating Scale (VSR) was assessed during the surgery and the acceptance 15 days later by a questionnaire. RESULTS: Thirty-two patients included. In all of the cases, the application of EMLA cream was sufficient, with the exception of one (fremulum plasty). General anesthesia was used for this patient unable to tolerate the proprioceptive sensations (VRS = 0). In cases of circumcision, the subcutaneous infiltration was not experienced as painful. Eighty-eight percent of patients who answered the questionnaire confirmed that if they had to be reoperated on, they would opt for this technique of anesthesia. CONCLUSION: EMLA cream is effective in minor penile surgery in adult patients, and it is associated with subcutaneous infiltration of local anesthetic in the case of circumcision.

Predictive value of 99Tcm-sestamibi gated SPET for long-term myocardial perfusion and functional recovery after an acute myocardial infarction.

We assessed the predictive value of 99Tcm-sestamibi gated single photon emission tomography (SPET) for changes in perfusion and functional outcome after an acute myocardial infarction and compared the findings on functional recovery with echocardiography using low-dose dobutamine. Gated 99Tcm-sestamibi SPET and radionuclide angiocardiography were performed in 17 patients 4-10 days after an acute myocardial infarction. Six months later, both isotopic studies and rest-dobutamine echocardiography were performed to assess outcome. Perfusion improved in six of seven severely hypoperfused segments (positive predictive value = 85.7%) that showed wall thickening but not in any of 28 segments (negative predictive value = 100%) without wall thickening. The mean ejection fraction improved from 47.7 to 52.3% (P = 0.018). Furthermore, there was a greater improvement in ejection fraction in the group of patients in whom wall thickening predicted a recovery in perfusion (9.0 vs 3.7%, P = 0.01). A comparison of the assessment of functional recovery between gated SPET and dobutamine echocardiography showed good agreement (81.4%). We conclude that the presence of wall thickening in severely hypoperfused segments on 99Tcm-sestamibi gated SPET is predictive of changes in perfusion and functional recovery after acute myocardial infarction, thus identifying the presence of viable myocardium. In contrast, segments showing hypoperfusion and dysfunction after an acute myocardial infarction probably contain scar tissue only.

The effect of different porosities in coral implants: an experimental study.

Goniopora lobata and polyphyllia talpina were tested in 10 sheep with a follow-up of 12 months. The reference material was a glass ceramic CAP 42. Different implantation sites are used: craniofacial and orthopaedic. A macro and microscopic postoperative study was performed at 3, 6, 9 and 12 months. The results show: (1) biocompatibility with bone and soft tissues; (2) disappearance, without colonisation, of Goniopora Lobata associated with complete bone regeneration at 12 months and (3) later resorption of polyphyllia talpina with a fibrous colonisation, without osseous transformation. The possibility of using these materials in cranio-maxillo facial surgery is discussed.

Tc-99m galactosyl-neoglycoalbumin hepatic scintigraphy in fulminant hepatic failure.

Tc-99m galactosyl-neoglycoalbumin (NGA) is a new liver imaging agent that specifically binds to a hepatocyte specific membrane receptor, the hepatic binding protein. Scintigraphy with Tc-99m NGA is a noninvasive method that provides functional images of the liver. This report deals with one case of fulminant hepatic failure in which hepatic scintigraphy with Tc-99m NGA predicted hepatic recovery before clinical and biochemical parameters, being a prognostic index in this patient.

[Contribution of digital venous angiography to the evaluation of arterial hypertension. Cost evaluation]. / Apport de l'angiographie numérisée par voie veineuse dans le bilan de l'hypertension artérielle. Evaluation du coût.

Concerning 100 intravenous digital subtraction angiographies (IV DSA) performed for the study of arterial hypertension, the results are discussed according to two different achievements: diagnostic and economic. One hundred patients have been examined after the intravenous (IV) injection of contrast material, seventy times in peripheral and thirty times in central venous system. Out of 94 examinations that could be interpreted, 10 revealed stenosis of renal arteries higher than 50 per cent, one revealed fibromuscular dysplasia. IV DSA generally permits the correct study of renal arteries and compared to conventional angiography it gives only a small number of false negative results. However, the reliable study of intrarenal vascularisation can be obtained only by renal arteriography. The renal arteriography remains therefore necessary: when renal IV DSA gives insufficient data; to estimate the degree of stenosis in fibro-muscular dysplasia; to evaluate intrarenal vascularisation before renovascular surgery or angioplasty. To estimate the economic validity of renal IV DSA for the study of arterial hypertension, we have investigated: the actual cost of the examination for a department of radiology, compared with the cost of conventional examination; on the other hand, the influence of this examination on the duration of hospitalisation for evaluation of arterial hypertension. According to our investigation, this examination allows the average reduction of expenses for 180 F per patient with arterial hypertension, and shortens the time of hospitalisation for about one day. Owing to this diagnostic and economic contribution, renal IV DSA is becoming the first examination to be done for the evaluation of renovascular hypertension.

[Drug consumption in diabetes mellitus (IV). The utilization of reactive material and systems for assessing blood glucose control from the viewpoint of primary care. The Group for the Study of Diabetes in Tarragona (GEDT)]. / Consumo de medicación en la diabetes mellitus (IV). Utilización de material reactivo y sistemas para asesorar el control glucémico desde la atención primaria. El Grup per a l'Estudi de la Diabetis a Tarragona (GEDT).

BACKGROUND: A study was performed to analyze the use of reactive material in the periodic follow up of diabetes. Likewise, the use of systems to assess glycemic control by primary care physicians was investigated. METHODS: Analysis of the habits of use of reactive material was performed on the diabetic population of Tarragona (548,900 inhabitants) by randomized survey of prescription in 525 patients attended in 12 primary care centers. The estimation of amount was carried out by a counting of the public prescriptions made. Similarly the periodicity and the results of the applications of glucoproteins in the reference laboratories were studied. RESULTS: A total of 253 diabetics (48%) were exclusively attended in the centers and 272 (52%) performed some type of home self-analysis; 26 (5%) in urine samples, and 246 (47%) in capillary blood. The estimated mean consumption was of 14 blood sugar strips per patient per month (168 strips/year) and 2.7 glucosuria-glucocetonuria strips (32.4 strips/year). The relative urine/blood ratio was 1/5.2. In 343 cases (65%) some glucoprotein measurement was reported within the last year, 330 (63%) corresponding to glucohemoglobin A1. The mean value was 8.3% (normal: 5-8%). The mean number of applications was 1.6 applications per patient per year. CONCLUSIONS: An enormous increase was observed in the amount consumed at the province of reactive material in blood and in the measurement of glucoproteins as the system to assess carbohydrate control in diabetes. A significant reduction was found in the use of reactive strips in urine by the diabetic population.

[Consumption of drugs in diabetes mellitus II. Utilization and loss of insulin: epidemiologic and socioeconomic implications. Study Group for Diabetes in Tarragona (GEDT)]. / Consumo de medicación en la diabetes mellitus (II). Utilización y pérdida de insulina: interés epidemiológico y socioeconómico. Grup per a l'Estudi de la Diabetis a Tarragona (GEDT).

BACKGROUND: With the aim of evaluating the real consumption on insulin an analysis of its loss with use in clinical practice was carried out. The influence of this loss was investigated in the calculations of prevalence of diabetes (DM) initiating from the consumption of medication, the presumable repercussion in public health costs and possible alternatives. METHODS: Revision and analysis of the recipients used by a group of 58 insulin treated diabetics was carried out during a mean period of one month. The theoretic consumption, real consumption and the mean loss per each injection according to visual accuracy and the system employed were evaluated. A deduction was made of the autonomy by storing of insulin. A previous calculation concerning the prevalence of DM in Tarragona (548,900 inhabitants) according to consumption was corrected and an economic estimation of the loss demonstrated over public health costs of insulin during 1991 was made. RESULTS: The mean dose prescribed was 39.7 IU/day supplied in 2.4 injections/patient/day. At 30 days (27-35) 310 recipients were evaluated (115 vials/195 boxes). The mean real dose consumed was 53.3 IU/day and the mean loss per injection was 5.6 (25.5% of all the insulin supplied, 4.5% as remnants at the bottom of the recipient). A greater loss was observed by injection a) in patients with reduced sight (6.4 +/- 7.3 IU/5.5 +/- 4.5; NS) and b) in the users of syringes with dead space (5.8 +/- 4.7) with respect to those using an injector insulin pen (4.4 +/- 2.9; p < 0.01). The autonomy by domiciliary storage of insulin was of 103.7 days/patient (prescribed doses) and 78.6 (real consumption). A total of 7 diabetics (12%) had unused expired recipients. The prevalence of insulin treated DM in Tarragona was estimated as around 4.3-4.8/1,000 (2,360-2,635 inhabitants). The expense of loss was 36 million pesetas/year; 6.4 as depreciated remnants of insulin in the bottom of recipients. CONCLUSIONS: There is a great loss of insulin in clinical practice which may be avoidable and which influences the public health costs for diabetes. An adequate educative strategy and system of injection independent of user ability would reduce the costs.

[Improving drug prescription in primary care: a controlled and randomized study of an educational method]. / Mejorar la prescripción de fármacos en atención primaria: un estudio controlado y aleatorio sobre un método educativo.

BACKGROUND: The aim of the present study was to assess whether educational intervention on the primary care physician may be an effective method to improve drug prescription. METHODS: An experimental randomized controlled study was carried out in 244 physicians of the management area No. 5 of the Institut Català de la Salut. Intervention consisted in 3 individualized interviews with the 123 physicians of the study group (IG), during which written informative material was also presented. The issues were: cerebral and peripheral vasodilators (CPVD) and antibiotics. The changes in the prescription of CPVD, combination of anti-infective agents with expectorants, mucolytics and/or balsamics (R05C1) and cephalosporins were specially evaluated in both groups. Subsequently, a stratified analysis was carried out depending on the volume of prescription of the physicians. RESULTS: The IG showed a greater reduction in the prescription of CPVD (9.78 bottles per physicians and months versus 6.43, p less than 0.01). The relative reduction in R05C1 prescription was also higher in the IG (12.3% versus 6.7%, p less than 0.01). The expenditure showed similar results. The use of oral cephalosporins increased in the IG and was reduced in the CG (p less than 0.01). CONCLUSIONS: The results show a favorable impact of personalized information in the groups with high prescription volume, which is particularly remarkable in the highest prescribers.