Resumen Objetivo: Identificar las creencias de los pacientes con riesgo cardiovascular, sobre la efectividad y seguridad de seguir hábitos de vida saludables y de tratamientos farmacológicos. Método: Estudio cualitativo, descriptivo y transversal, realizado mediante entrevistas semiestructuradas y entrevistas en profundidad, en el ámbito de la farmacia comunitaria. Los participantes fueron pacientes voluntarios atendidos en Zaragoza. Resultados: Los resultados más relevantes hacen énfasis en la actitud receptiva de los pacientes tanto frente a los hábitos saludables, como a los tratamientos farmacológicos. Destaca la creencia en la efectividad de ambas medidas terapéuticas, y que es su combinación lo que lleva al éxito del tratamiento. Los pacientes muestran preocupación ante la posibilidad de sufrir efectos adversos de los medicamentos mientras que las medidas higiénico-dietéticas son percibidas como seguras. Los pacientes muestran confianza hacia los profesionales sanitarios. En cuanto a los cambios de hábitos, se detectaron dificultades relacionadas con las dimensiones cultural, social y emocional. Conclusiones: La perspectiva de los pacientes entrevistados coincide con las recomendaciones biomédicas actuales sobre la prevención y tratamiento de las enfermedades cardiovasculares: se precisa de una terapéutica mixta para el manejo del riesgo cardiovascular. Los pacientes confían en los profesionales sanitarios. Aun así, los pacientes temen por la seguridad de los medicamentos y sienten dependencia del sistema experto en el manejo de su condición de salud. En la atención a los pacientes es necesario tener en cuenta sus creencias, condiciones y experiencias para adecuar las terapias y obtener el máximo beneficio de éstas.

Summary Objective: To identify the beliefs of patients with cardiovascular risk, about effectiveness and safety of following healthy life habits and drug therapy. Methods: Qualitative, descriptive, and cross-sectional study, in-depth semistructured interviews were conducted in the community pharmacy setting. Participants were volunteer patients from Zaragoza (Spain). Results: The most relevant results emphasize the receptive attitude of patients both in terms of healthy habits and pharmacological treatments. It emphasizes the belief in the effectiveness of both therapeutic measures and that it is their combination that leads to the success of the treatment. Patients show concern about the possibility of suffering adverse effects of medications, while hygienicdietetic measures are perceived as safe. Patients show confidence in health professionals. Regarding habits changes difficulties were detected related to the cultural, social and emotional dimensions. Conclusions: The beliefs of the patients coincide with the current biomedical recommendations on the prevention and treatment of cardiovascular diseases: a mixed therapy is required for the management of cardiovascular risk. In addition, patients rely on health professionals. Even so, patients fear for the safety of medications and feel dependent on the expert system in managing their health condition. In patient care, it is necessary to consider patients’ beliefs, conditions and experiences to adapt therapy to the maximum and obtain the maximum benefit from it.

ABSTRACT The effect of using natural growth promoters (NGP) to replace traditional antimicrobials on performance, biometry of digestive and reproductive organs, sexual maturity and bone characteristics of replacement pullets was evaluated; and the relationship between these variables according to the diets was verified. Eight-week-old birds were randomly assigned to a completely randomized design and fed different diets: negative control (without growth promoters); positive control - conventional growth promoter; organic acids (OA); symbiotic (S); essential oil (EO); OA + S; and EO + S. The performance, relative weight of digestive and reproductive organs and length intestines, height and crest length, sternum length, bone quality and sexual maturity of birds were similar (p>0.05) between treatments. The heat map combined with cluster analysis showed a uniform static pattern with the formation of three horizontal groups formed by the treatments: 1) negative control, S and OA + S; 2) positive control and OE and 3) OA and OE + S. A null relationship between the treatments and the variables under study was observed. The principal components analysis revealed an association of variables in three components with 60.55% of variation. NGP can replace traditional promoters, as they do not interfere with performance, biometrics or sexual maturity. Height and length are predictive variables for the development of reproductive organs, especially the oviduct. A similarity was identified through multivariate techniques between symbiotic and organic + symbiotic acids; positive control and essential oils; and organic and symbiotic acids + essential oils.

Abstract Objective: Determine implementation results of the Comprehensive Medication Management (CMM) offered to patients with chronic kidney disease (CKD) who attended the Hospital Nephrology Service in Costa Rica. Methods: Mixed quantitative-qualitative, observative, descriptive and prospective study, in patients attending the Hospital Pharmaceutical Care Department through the CMM process, analysis of intermediate and preliminary results of health-related quality of life HRQOL using EQ 5D -5L. Results: Based on pilot study, 11 patients attended the first visit and 9 patients attended the third one. As result, 45 clinical conditions were analyzed, 1 of them was resolved, 20 were stable and 10 were improved. Total of 62 drug-therapy problems (DTP) were identified, with average of 5.6/patient. On regards to HRQOL, feedback obtained from kidney transplant patients indicated a better evaluation (mobility, personal care, daily activities, pain / discomfort), compared to CKD stage 5 5D dialysis patients (mobility impairment improvement). Utility measure reflected a change of 0.64±0.12 to 0.72±0.12, the health self-perception EQ VAS 68.18±23.58, to 87.22±8.53; and in terms of qualityadjusted life-year QALY, it showed a difference of 2.54±2.99. Conclusions: CMM implementation established in most health conditions improve or maintain patient stability. HRQOL was better for transplant patients compared to CKD 5D patients. Parameters such as utility, QALY, and EQ VAS were increased.

Resumen Objetivo: Determinar los resultados de la implantación del Comprehensive Medication Management (CMM) brindada a los pacientes con enfermedad renal crónica (ERC) que asistieron al Servicio de Nefrología de un Hospital en Costa Rica. Métodos: Estudio cuali-cuantitativo mixto, observacional, descriptivo y prospectivo, en pacientes que asisten al consultorio de Atención Farmacéutica de un hospital, mediante el proceso asistencial CMM, análisis de resultados intermedios y preliminares de calidad de vida relacionada con salud (CVRS) mediante EQ 5D-5L. Resultados: En el estudio piloto 11 pacientes completaron la primera visita y 9 pacientes la tercera visita; se analizaron 45 condiciones clínicas, y se obtuvo una condición clínica resuelta, 20 estables, 10 con mejoría. Se identificaron 62 problemas farmacoterapéuticos (DTP por sus siglas en inglés), media 5,6/paciente. Respecto a la CVRS los discursos de los pacientes trasplantados renales indicaron una mejor valoración (movilidad, cuidado personal, actividades cotidianas, dolor/malestar), en comparación con pacientes ERC estadio 5 diálisis 5D (mayor afectación movilidad). La utilidad cambió de una media 0,64±0,12 a 0,72±0,12, la autopercepción de salud EQ VAS 68,18±23,58, a 87,22±8,53; y respecto a los años de vida ganados ajustados por calidad de vida AVAC con una diferencia de 2,54±2,99. Conclusiones: La implantación de CMM logró en la mayoría de las condiciones de salud una mejoría o mantener la estabilidad. La CVRS fue mejor para los pacientes trasplantados, en comparación con los pacientes ERC 5D. Los parámetros como la utilidad, AVAC y EQ VAS aumentaron.