Medication regimen complexity in institutionalized elderly people in an aging society

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist’s intervention to reduce it as part as the medication review routine in all the patients.

Heterozygosity decrease in wild boar mating system. A case of outbreeding avoidance?

In sexually reproducing organisms, the specific combinations of parental alleles can have important consequences on offspring viability and fitness. Accordingly, genetic relationship between mates can be used as a criterion for mate choice. Here, we used microsatellite genetic markers to estimate the genetic relationship between mating pairs in the wild boar, Sus scrofa. Males, females and foetuses proceeding from Portugal, Spain and Hungary were genotyped using 14 microsatellite markers. The genetic relationship between mates was estimated using different measures of foetus heterozygosity. We found that the observed heterozygosity of foetuses was lower than that expected under random mating. This result occurred mainly when Sd2 (relatedness of parental genomes) was used as the heterozygosity measure. After simulations, we concluded that the observed low heterozygosity was possibly due to outbreeding avoidance. Outbreeding avoidance based on genetically different genomes might play an important role in species evolution and its genetic conservation.