Palabras clave:Nutrición enteral. Soporte nutricional. Cuidados domiciliarios. Gasto en medicación. ResumenIntroducción: el escenario de la nutrición enteral domiciliaria (NED) en Murcia, antes de 2010, estaba caracterizado por la gran variabilidad en la consideración del paciente subsidiario de dicha prestación, así como por el elevado consumo respecto a otras comunidades autónomas. Objetivos: desarrollar y describir la implementación de una vía clínica de asistencia al paciente subsidiario de NED y analizar el perfi l de los pacientes y las características del soporte nutricional. Método: puesta en marcha de la vía clínica en el Área I de salud del Servicio Murciano de Salud (SMS). Diseño observacional y ambispectivo. Análisis de las muestras de NED de adultos del Área I en los años 2010 (NED1) y 2013-14 (NED2), con 345 y 457 casos, respectivamente. Resultados: instrucción nº 4/2012 de 12 de julio, Dirección de Gerencia del SMS, que generaliza la vía clínica a todas las áreas de salud. Aunque la patología más prevalente en ambas muestras fue la neurológica, seguida de la oncológica y la digestiva, hubo diferencias signifi cativas en la distribución. La NED1 presentó un alto porcentaje de casos de pacientes no subsidiarios de prestación. En ambas muestras, la vía más frecuente de administración fue la oral, pero con una tendencia inversa en sonda nasogástrica (SNG) y gastrostomía en NED2, donde las fórmulas específi cas también se redujeron. Conclusiones: los perfi les de la NED antes y después de la implantación de la vía clínica difi eren signifi cativamente en la patología de base, la vía de administración y el tipo de fórmula utilizada. La vía clínica ha facilitado la racionalización de la prescripción de esta prestación sanitaria. . Although most prevalent diseases in both samples were neurological, followed, with a wide spread, by oncological and digestive cases, there was a signifi cant difference regarding distribution. The HEN1 sample showed a great number of no candidate patients according to the management statement. In both samples, the most prevalent route of administration was oral, but with a trend reversal to feeding tube and gastrostomy in HEN2, where the specifi c formulas were also reduced. Conclusions: The profi le of HEN, before and after the deployment of the clinical pathway, changes signifi cantly concerning the main disease, the route of administration and the formula. It has been proved that there is a need for controlling HEN for an appropriate prescription.

Genetically informative designs and, in particular, twin studies, are the most widely used methodology to analyse the relative contribution of genetic and environmental factors to inter-individual variability. These studies basically compare the degree of phenotypical similarity between monozygotic and dizygotic twin pairs. In addition to the traditional estimate of heritability, this kind of registry enables a wide variety of analyses which are unique due to the characteristics of the sample. The Murcia Twin Registry is population-based and focused on the analysis of health-related behaviour. The observed prevalence of health problems is comparable to that of other regional and national reference samples, which guarantees its representativeness. Overall, the characteristics of the Registry facilitate developing various types of research as well as genetically informative designs, and collaboration with different initiatives and consortia.

AM. Nutrición enteral domiciliaria en la Región de Murcia. Perfi l de la muestra, evolución del coste y perspectiva. Años 2007-2010. Nutr Hosp 201633:1022-1026 AbstractIntroduction: It was 2010 when the prescription of home enteral nutrition (HEN) in Murcia changed restricting this task to those physicians with skills for it. Objectives: To evaluate key aspects of this registry data over 2007-2010; sample characteristics, cost trends and future prospects. Methods: Retrospective study of the HEN population profi le in one specifi c health area and HEN products billed in the whole region; analysis of the chosen formula and changes concerning prescriptions and its value during 2007-2010. Results: Regarding the profi le of the specifi c area (Area I de Salud de la Región de Murcia), indication, route of administration and type of formula most frequent were, respectively, neurological disease, oral, and non-specifi c nutrition. On the other hand, health expenditure in these products concerning the Murcia Health Service increased about 50% in both aspects, number of prescriptions and amount between 2007 and 2010. Compared with the rest of the country, Murcia is above the national average. Conclusions: The profi le of this specifi c area does not match with other published works, moreover, the expense in nutrition and the clear upward trend during this period clarify the need for steps to improve the quality of the HEN in the Region of Murcia and try to reach national values related to average consumption and spending.

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