Objective: To evaluate the association between use of benzodiazepines and incident dementia. Methods: Analytical prospective nested case-control study for which the Spanish database for pharmacoepidemiological research in primary care (BIFAP) of the Spanish Agency of Medicines and Medical Devices (AEMPS) was used. A total of 15,212 subjects diagnosed with dementia of the Alzheimer type and 62,397 controls were identified. Exposure was retrieved retrospectively with a 3-year lag time before the index date. Adjusted odd ratios (OR) were calculated. Results: Benzodiazepines use increased the risk of suffering Alzheimer's disease (OR = 1.05, 95% CI, 1.01-1.10). No statistical differences were shown between short-acting and long-acting drugs. The risk is more evident with longer exposure times. Conclusions: There seems to be a weak association between benzodiazepine use and the development of dementia, the risk increases with greater exposure. (C) 2020 Elsevier Espana, S.L.U. All rights reserved.

La educación interprofesional (EIP) es clave para garantizar el aprendizaje integrado de los alumnos de diferentes titulaciones, que ejercerán una labor profesional basada en el cuidado centrado en la persona, de manera conjunta. El proyecto de EIP de la Universidad de Navarra pretende dar a los alumnos de medicina, enfermería y farmacia los conocimientos, habilidades y actitudes necesarias para trabajar de manera interprofesional, centrándonos en trabajo en equipo, conocimiento y respeto de roles, resolución de conflictos y comunicación interprofesional. Para ello, el equipo de docentes implicados en este proyecto ha tenido que trabajar colaborativamente, experimentando las claves de este trabajo interprofesional, centrado en el alumno, constituyendo una experiencia enriquecedora, constructiva, y que ha aportado las claves del trabajo en equipo necesario para llevar a cabo un proyecto docente de EIP.

La asistencia sanitaria centrada en el paciente es la clave para una atención humana a la persona y a su familia. La práctica colaborativa en equipos interprofesionales resulta imprescindible para alcanzar una atención sanitaria de calidad. La universidad tiene la responsabilidad de preparar a sus graduados para trabajar en equipos interprofesionales. Una enseñanza/aprendizaje centrada en la persona, fundamentada en las competencias que definen la educación interprofesional, es clave para que nuestros estudiantes reconozcan la necesidad del trabajo colaborativo. Este artículo detalla un proyecto docente de educación interprofesional de la Universidad de Navarra, donde estudiantes de las facultades de medicina, enfermería y farmacia aprenden juntos y de manera gradual, las claves de cómo trabajar en equipo.

Community pharmacists play an important role in the provision of health promotion services, and community pharmacies are considered as a potentially ideal site for cardiovascular health promotion. Information based on a systematic review of barriers to promoting cardiovascular health in community pharmacy is currently lacking. We have sought to identify the most important barriers to cardiovascular health promotion in the community pharmacy. We have systematically searched PubMed and International Pharmaceutical Abstracts for a period of 15 years from 1 April 1998 to 1 April 2013, contacted subject experts and hand-searched bibliographies. We have included peer-reviewed articles, with English abstracts in the analysis, if they reported community pharmacists' perceptions of the barriers to cardiovascular health promotion activities in a community pharmacy setting. Two reviewers have independently extracted study characteristics and data. We identified 24 studies that satisfy the eligibility criteria. The main barriers to cardiovascular health promotion in the community pharmacy included pharmacist-related factors; practice site factors; financial factors; legal factors; and patient-related factors. This review will help to provide reliable evidence for health promotion practitioners of the barriers to promoting cardiovascular health in the community pharmacy setting. This knowledge is valuable for the improvement of cardiovascular health promotion in this setting and guiding future research.

Methylenedioxymethamphetamine (MDMA) causes a persistent loss of dopaminergic cell bodies in the substantia nigra of mice. Current evidence indicates that MDMA-induced neurotoxicity is mediated by oxidative stress probably due to the inhibition of mitochondrial complex I activity. In this study we investigated the contribution of dopamine (DA) to such effects. For this, we modulated the dopaminergic system of mice at the synthesis, uptake or metabolism levels. Striatal mitochondrial complex I activity was decreased 1h after MDMA; an effect not observed in the striatum of DA depleted mice or in the hippocampus, a dopamine spare region. The DA precursor, L-dopa, caused a significant reduction of mitochondrial complex I activity by itself and exacerbated the dopaminergic deficits when combined with systemic MDMA. By contrast, no damage was observed when L-dopa was combined with intrastriatal injections of MDMA. On the other hand, dopamine uptake blockade using GBR 12909, inhibited both, the acute inhibition of complex I activity and the long-term dopaminergic toxicity caused by MDMA. Moreover, the inhibition of DA metabolism with the monoamine oxidase (MAO) inhibitor, pargyline, afforded a significant protection against MDMA-induced complex I inhibition and neurotoxicity. Taken together, these findings point to the formation of hydrogen peroxide subsequent to DA metabolism by MAO, rather than a direct DA-mediated mitochondrial complex I inhibition, and the contribution of a peripheral metabolite of MDMA, as the key steps in the chain of biochemical events leading to DA neurotoxicity caused by MDMA in mice.

Pharmacy students have a difficulty in implementing the theoretical pharmacotherapy knowledge into practice, during their Advanced Pharmacy Practice Experiences (APPEs). The objective of this work was to evaluate the effectiveness of a teaching tool to guide students¿ self-directed pharmacotherapy learning. Students checked their own knowledge about: generic name, drug class, indication, dosage, potential adverse reactions and interactions, of 10 prescription drugs per week, during six months of practical training. Students recorded a self-assessment of their level of knowledge of prescription drugs using an answer sheet. The effectiveness was determined by a pharmacotherapy knowledge test at the beginning and end of the APPE. Thirty two students who set up this exercise were evaluated and compared to control group (n = 30). Results showed improvement between the intervention and control students' pre-test and post-test pharmacotherapy knowledge (p=0.001). Additionally, student learning development was measured as the percentage of correct answers, related to students¿ level of pharmacotherapy knowledge, filled out using the answer sheet, in the course of the 6 months of APPE. Analysis of 8 answer sheets showed an increment of pharmacotherapy learning during six months. ¿Indication¿ and ¿drug class¿ displayed the biggest percentage of correct answer in the first month, while ¿dosage¿, ¿interactions¿ and ¿adverse reactions¿ showed the least percentage of correct answer at this time. Besides, this analysis allowed the identification of commonly prescription drugs, both in community pharmacy and hospital pharmacy. The overall students `opinion was very positive. Designed method improved student¿s self-directed learning, identifying their own knowledge in pharmacotherapy, during APPE.

Introducción: La adhesión a un patrón de Dieta Mediterránea está asociado a una reducción de la morbi-mortalidad, y a una mejora de la calidad de vida. Objetivos: Evaluar una intervención nutricional en personas mayores independientes a través de un programa de educación que favorezca el conocimiento de los alimentos y la confección de dietas adecuadas, promocionando un patrón de dieta saludable. Métodos: Estudio cuasi-experimental realizado en un colectivo de personas mayores que residen en apartamentos tutelados del Ayuntamiento de Pamplona (n = 41). La intervención consistió en seis sesiones de educación grupal y una entrevista motivacional individual en un periodo de tres meses. Se evaluó la adhesión a la Dieta Mediterránea a través de un cuestionario de 14 puntos previamente validado. Resultados: El 80,5% de los participantes fueron mujeres, con una mediana de edad de 79 años, en gran proporción viudas (48,8%) y con estudios primarios (58,5%). Tras la intervención nutricional el porcentaje de participantes que consumió dos o más raciones de verduras u hortalizas aumentó significativamente con respecto al grupo control (p = 0,042). De forma similar en comparación con el grupo control hubo un mayor incremento en el porcentaje de individuos que consumían 3 raciones de legumbres a la semana (p = 0,042), 3 o más veces por semana frutos secos (p = 0,003) y que tomaban preferentemente carne de pollo, pavo o conejo en vez de ternera, cerdo, hamburguesas o salchichas (p = 0,011).

Background: The impact of simulation on pharmacy students has been demonstrated in pharmacy education. However, in Spain, to date, there have been no published studies that offer evidence of the utilization of this methodology in pharmacy education. Objective: Patient simulation teaching was introduced to «Pharmaceutical care» subject. Specific objectives of the present work were to present case scenarios to pharmacy students in order to enhance their classroom learning with an opportunity to practice communication skills and apply knowledge in a safe setting and evaluate its impact on students¿ satisfaction. Method: Students were assigned to groups and play the role of pharmacists in a community pharmacy setting in which 10 simulated patients experienced 10 case scenarios. After the practice the students were asked to complete an anonymous questionnaire regarding their impressions about the patient simulation training in terms of usefulness and usability. Results: 58 students responded to the questionnaire (83% response rate). Students indicated high levels of satisfaction with the experience. Overall students expressed that the methodology was novel in its formation (98.3%). The methodology favoured the transfer of knowledge into practice (94.8%). The practice helped them to recognize the difficulties for efficient communication (91.4%). Students confirmed the need for this practice with patients in the pharmacy curriculum (93.1%). Besides, a survey instrument was administered to fifth-year students during their advanced Pharmacy Practice experience (aPPe). These students underwent patient simulation teaching during the previous for- mation year. Student¿s responses confirmed that pharmacy practice simulation training made them aware of the preparation that is needed to take care of pa- tients. Conclusion: Simulated-patient training facilitates the learning outcomes needed to practice pharmaceutical care.

Objective: To identify the factors associated to the number of medication changes (MC) in institutionalized elderly. Method: Prospective study conducted during four months. The number of MC was recorded weekly. We analyzed the factors associated with a high number of changes (four or more), calculating the Odds Ratio as a measure of association and the Fisher's exact test for statistical significance. Results: 997 MC were recorded in 234 elderly. 42.7% of the patients had four or more MC. The factors associated with a high number of MC were, chronic renal failure, immobility syndrome, loss of visual acuity, comorbidity, and polypharmacy. Conclusions: A high number of MC is associated with factors considered as risk indicators of drug-related problems. The number of MC in institutionalized patients may be an indicator to prioritize medication review.