Olive mill wastewater-evaporation ponds long term stored: Integrated assessment of in situ bioremediation strategies based on composting and vermicomposting.

During the last two decades, the method most widely used to manage olive mill wastewater (OMW) derived from olive oil production has been its disposal in evaporation ponds. Long-term storage of OMW leads to the accumulation of toxic sediments (OMWS) rich in recalcitrant compounds with phytotoxic and antimicrobial properties, which limit their use for agronomic purpose. The aim of this study was to compare the effect of two in situ bioremediation strategies (composting and a combination of composting followed by vermicomposting) to remove the potential toxicity of the sediments derived from long-term stored OMW. The results obtained showed that the composting method assisted with the earthworms enhanced the depletion of phenolic compounds and OMWS ecotoxicity more than composting, especially during the maturation stage. Moreover, vermicomposting was more effective in the reduction of the OMWS salinity. However, a pre-composting process to the OMWS is necessary prior to vermicomposting to provide the suitable conditions for earthworms survival and activity. Furthermore, the final compost showed a phytostimulating effect. Therefore, these in situ bioremediation strategies can be considered potential tools for decontamination and recovery of long-term stored OMWS in evaporation ponds, which currently poses an unsolved environmental problem.

Location-scale mixed models and goodness-of-fit assessment applied to insect ecology.

Survival models have been extensively used to analyse time-until-event data. There is a range of extended models that incorporate different aspects, such as overdispersion/frailty, mixtures, and flexible response functions through semi-parametric models. In this work, we show how a useful tool to assess goodness-of-fit, the half-normal plot of residuals with a simulated envelope, implemented in the hnp package in R, can be used on a location-scale modelling context. We fitted a range of survival models to time-until-event data, where the event was an insect predator attacking a larva in a biological control experiment. We started with the Weibull model and then fitted the exponentiated-Weibull location-scale model with regressors both for the location and scale parameters. We performed variable selection for each model and, by producing half-normal plots with simulated envelopes for the deviance residuals of the model fits, we found that the exponentiated-Weibull fitted the data better. We then included a random effect in the exponentiated-Weibull model to accommodate correlated observations. Finally, we discuss possible implications of the results found in the case study.

Composting of the invasive species Arundo donax with sewage and agri-food sludge: Agronomic, economic and environmental aspects.

This work evaluates several co-composting scenarios based on the use of Arundo donax biomass (AD) as bulking agent for the co-composting of sewage sludge (MS) and agri-food sludge (AS), to manage these organic wastes and to produce balanced organic fertilizers by optimizing the process. For this, six piles were prepared in commercial composting conditions, using AD in a range of 40%-80% (on a dry weight basis). Physico-chemical and chemical parameters and the thermal behaviour were evaluated during the process, as were the physical and chemical parameters of the final composts. The proportion of AD in the mixtures has a significant effect on the development of the thermophilic stage of composting, showing the piles with higher proportion of AD a quicker organic matter degradation. In addition, the evolution of the thermal indices R1 and R2 was different depending on the origin of the sludge used, indicating an increase in the relative concentration of more recalcitrant materials in the piles prepared with AS. The estimation of the global warming potential showed that the use of higher proportion of AD in the composting mixture may be a strategy to mitigate the emission of greenhouse gases during the composting process. Moreover, the end-products obtained had an additional marketable value, with a balanced nutrient content and a good degree of maturity, which indicates the viability of the composting process as a method for the stabilization of these organic wastes.

Development of organic fertilizers from food market waste and urban gardening by composting in Ecuador.

Currently, the management of urban waste streams in developing countries is not optimized yet, and in many cases these wastes are disposed untreated in open dumps. This fact causes serious environmental and health problems due to the presence of contaminants and pathogens. Frequently, the use of specific low-cost strategies reduces the total amount of wastes. These strategies are mainly associated to the identification, separate collection and composting of specific organic waste streams, such as vegetable and fruit refuses from food markets and urban gardening activities. Concretely, in the Chimborazo Region (Ecuador), more than 80% of municipal solid waste is dumped into environment due to the lack of an efficient waste management strategy. Therefore, the aim of this study was to develop a demonstration project at field scale in this region to evaluate the feasibility of implanting the composting technology not only for the management of the organic waste fluxes from food market and gardening activities to be scaled-up in other developing regions, but also to obtain an end-product with a commercial value as organic fertilizer. Three co-composting mixtures were prepared using market wastes mixed with pruning of trees and ornamental palms as bulking agents. Two piles were created using different proportions of market waste and prunings of trees and ornamental palms: pile 1 (50:33:17) with a C/N ratio 25; pile 2: (60:30:10) with C/N ratio 24 and pile 3 (75:0:25) with C/N ratio 33), prepared with market waste and prunings of ornamental palm. Throughout the process, the temperature of the mixtures was monitored and organic matter evolution was determined using thermogravimetric and chemical techniques. Additionally, physico-chemical, chemical and agronomic parameters were determined to evaluate compost quality. The results obtained indicated that all the piles showed a suitable development of the composting process, with a significant organic matter decomposition, reached in a shorter period of time in pile 3. At the end of the process, all the composts showed absence of phytotoxicity and suitable agronomic properties for their use as organic fertilizers. This reflects the viability of the proposed alternative to be scaled-up in developing areas, not only to manage and recycle urban waste fluxes, but also to obtain organic fertilizers, including added value in economic terms related to nutrient contents.

Correlación de diferentes métodos de valoración de la rigidez matinal con índices de actividad y discapacidad en pacientes con artritis reumatoidea / Correlation of different methods of assessment of morning stiffness with activity and disability indexes in patients with rheumatoid arthritis

La rigidez matinal (RM) es un síntoma complejo en los pacientes con AR. Existen diferentes formas de valorar la RM. Sin embargo, la mejor manera de evaluarla es aún controversial. Objetivos: Comparar la severidad y la duración de la RM, evaluada por el médico y por cuestionarios autorreportados, con la actividad de la enfermedad y la capacidad funcional en pacientes con AR. Métodos: Estudio observacional de corte transversal. Se incluyeron pacientes con diagnóstico de AR. Se consignaron datos demográficos, características de la AR y medidas clinimétricas. Los pacientes fueron asignados aleatoriamente a uno de dos grupos: el primer grupo fue interrogado sobre la duración de la RM en minutos; el segundo grupo fue evaluado mediante un cuestionario autorreportado que cuantificaba la severidad de la RM (EVA numérica y no numérica) y la duración (en minutos y en escala de Likert). Resultados: Participaron 111 pacientes (86% mujeres). La edad media fue de 52 años y la mediana de duración de la enfermedad fue 8 años. El 51% presentaba RM. La correlación de la RM en minutos medida por el médico fue buena con HAQ-A y aceptable con DAS28 y CDAI; mientras que la severidad medida por EVA correlacionó mejor con los índices de actividad de la AR que con discapacidad. Cuando la intensidad de la RM fue evaluada por EVA se observó que un valor >5,5 cm se asoció con actividad severa de la enfermedad (Sensibilidad: 44%; Especificidad: 100%). Conclusión: La duración de la rigidez matinal, evaluada en minutos por el médico, estaría relacionada tanto con la actividad de la enfermedad como con la discapacidad. La intensidad de la rigidez matinal se asoció más fuertemente con la actividad inflamatoria en los pacientes con AR

Desempeño del RAPID3 (Routine Assessment of Patient Index Data) en pacientes con osteoartritis de rodilla, cadera o mano / RAPID3 (Routine Assessment of Patient Index Data) performance in patients with osteoarthritis of the knee, hip or hand

RAPID3 es un cuestionario autorreportado desarrollado originalmente para valorar pacientes con AR. Recientemente fue empleado en pacientes con OA de rodillas y/o caderas con buenos resultados. Objetivo: Determinar si existe correlación entre el RAPID3 y otros cuestionarios en pacientes con OA de manos (AUSCAN), cadera y/o rodilla (WOMAC) y comparar el tiempo para su realización y cálculo. Material y métodos: Estudio analítico observacional de corte transversal. Se incluyeron pacientes consecutivos ≥50 años con diagnóstico de OA de rodillas, caderas y/o manos que completaron el RAPID3; además el AUSCAN y/o WOMAC según la localización de la OA. Se midió el tiempo para completar y calcular los cuestionarios. Resultados: Se incluyeron 104 pacientes. Al comparar RAPID3 con WOMAC y AUSCAN se observó una correlación de 0,66 y 0,62 respectivamente (p<0,01). Al evaluar RAPID3 con la subescala de función del WOMAC, la correlación fue de 0,75 (p<0,01) y con WOMAC Ab de 0,68 (p<0,001). El tiempo para completar y calcular el RAPID3 fue menor que para los otros cuestionarios. Conclusión: Se observó buena correlación entre RAPID3, WOMAC y AUSCAN, requiriendo un menor tiempo para su realización y cálculo. Por lo tanto, podría ser una herramienta útil para evaluar pacientes con OA de rodilla, caderas y/o manos

Simplification of antiretroviral therapy: a good choice for our patients and the sustainability of our health care system.

OBJECTIVE: To describe the efficacy, safety, compliance and cost savings of lopinavir/ritonavir monotherapy. METHOD: Observational, descriptive and retrospective study evaluating monotherapy. Adherence was calculated using an objective method. We estimated the direct costs of dispensing non-triple therapy. RESULTS: We identified 17 patients. Interval adherence was > 95% in 9 patients, 90-95% in 2 patients, 90-85% in 2 patients, and less than 85% in 4 patients. Viral load was undetectable during weeks 12, 24, 36 and 48, except in 2 patients. The CD4 count in most analytical tests remained at > 350 cells/ml, only 1 patient had a lower figure. The average savings was 4819 Euros/patient/year (range 1116 to 8700). CONCLUSIONS: In selected patients, monotherapy can be a cost-effective treatment option.

Validación de una versión argentina del Health Assessment Questionnaire-II (HAQ-II) / Validation of an Argentine version of the Health Assessment Questionnaire-II (HAQ-II)

La versión argentina de Health Assessment Questionnaire (HAQ-A) es un instrumento útil para documentar el estado clínico, la evolución y el pronóstico funcional de nuestros pacientes con Artritis Reumatoidea (AR). Sin embargo, presenta algunas limitaciones. Esto dio lugar a una versión más simple: el HAQ-II, el cual consta de 10 preguntas. Nuestro objetivo fue determinar la reproducibilidad y validez de una versión argentina del HAQ-II en pacientes con AR. Material y métodos: Se incluyeron pacientes consecutivos con diagnóstico de AR (ACR ‘87) de 4 centros reumatológicos de Argentina. La versión original del HAQ-II fue traducida por 3 reumatólogos argentinos y retraducida al inglés por un individuo bilingüe no relacionado. La reproducibilidad del cuestionario fue evaluada en el 30% de los pacientes con un segundo cuestionario completado dentro de los 3 a 7 días de la primera visita. La validez constructiva fue evaluada comparando el HAQ-II con parámetros clásicos de actividad de la enfermedad, capacidad funcional y compromiso radiológico (medido por el método de Sharp van der Heijde). Se evaluó también el tiempo y dificultad para realizarlo, así como la confiabilidad y correlación con HAQ-A. Resultados: 97 pacientes fueron incluidos, de los cuales el 82% eran mujeres, 95% seropositivas para factor reumatoideo, 87% erosivas y 22% nodulares. La reproducibilidad del HAQ-II fue buena (r=0,94). En la correlación intraítem se halló una única redundancia (entre la pregunta 8 y 9 (r=0,92)), por este motivo la pregunta 8 fue reemplazada manteniendo excelente correlación con la versión original (r=0,99). El HAQ-II tuvo buena correlación con EVA (escala visual análoga) para dolor, EVA para actividad y articulaciones dolorosas; regular correlación con recuento de articulaciones inflamadas, menor nivel educativo y eritrosedimentación (ERS). No se observó correlación con daño radiológico.

[Preparation of a safety plan in a Clinical Medication Management Unit]. / Elaboración de un plan de seguridad en una unidad de gestión clínica del medicamento.

INTRODUCTION: Patient safety is seen as a priority in health care, and is becoming an increasingly complex activity, which involves potential risks. There is still no system that guarantees the absence of adverse events. The aim of this study was to prepare a Safety Plan for a Clinical Drugs Management Unit. METHOD: A risk assessment was made of the Clinical Drugs Management Unit over a 2 month period. To do this, a case form was distributed in which members of the Department reflected on the lack of safety in their working environment. The prioritising of the items selected from a risk matrix was analysed using the adapted Hanlon method. RESULTS: A total of 55 specific risks were identified in 8 sections of pharmacy: 11 chemotherapy unit, 11 single dose, 9 nursing sick bay kits, 8 pharmacotechnical, 5 traditional dispensing, 4 intravenous mixtures unit, 4 pharmacy care unit, and 3 pharmacy stores. After prioritisation, the Clinical Drugs Management Unit Safety Plan was prepared. It looked at 11 items: Pharmacotechnical area 7, single dose 1, nursing sick bay kits 1, traditional dispensing 1 and personnel management 1. CONCLUSIONS: Preparing a Safety Plan has enabled us to identify and prioritise our safety activities and in general to make health staff more aware of the importance of patient safety.

Composting of animal manures and chemical criteria for compost maturity assessment. A review.

New livestock production systems, based on intensification in large farms, produce huge amount of manures and slurries without enough agricultural land for their direct application as fertilisers. Composting is increasingly considered a good way for recycling the surplus of manure as a stabilised and sanitised end-product for agriculture, and much research work has been carried out in the last decade. However, high quality compost should be produced to overcome the cost of composting. In order to provide and review the information found in the literature about manure composting, the first part of this paper explains the basic concepts of the composting process and how manure characteristics can influence its performance. Then, a summary of those factors such as nitrogen losses (which directly reduce the nutrient content), organic matter humification and compost maturity which affect the quality of composts produced by manure composting is presented. Special attention has been paid to the relevance of using an adequate bulking agent for reducing N-losses and the necessity of standardising the maturity indices due to their great importance amongst compost quality criteria.

[Effectiveness of medical counseling for alcoholic patients and patients with excessive alcohol consumption seen in primary care]. / Efectividad del consejo médico a pacientes alcohólicos y bebedores excesivos atendidos en consultas de atención primaria.

AIM: To determine the effectiveness of medical counseling for alcohol abuse, when it is provided in primary care centers. DESIGN: Quasi-experimental, open, multicenter before-after study.Setting. 14 primary care physician's practices (7 rural, 7 urban) in the province of Córdoba (Spain). PARTICIPANTS: 306 patients of both sexes, recruited with a case-finding strategy, who consumed >=35 (men) or >=21 (women) IU per week, or who had alcohol dependence syndrome (ADS) (MALTS score O>=11). Interventions. All patients were offered brief counseling to reduce drinking, and all were followed to evaluate their status 3 months, 1 year and 2 years later. MAIN MEASURES: The response variable was self-reported alcohol consumption together with normal GGT values or confirmation of alcohol consumption by a relative. The results were subjected to intention-to-treat analysis. RESULTS: Of the 306 patients included in the study, 95.1% were men and 78.4% had ADS. After 2 years 38.89% (95% CI, 32.2%-44.3%) had attained their treatment goal: 23.85% were in complete abstinence, and 15.0% consumed moderate amounts of alcohol below the limit considered to indicate risk. Starting excessive consumption at less than 16 years of age (odds ratio [OR], 3.0885), living in a slum (OR, 3.2103), smoking (OR, 1.7187), and a positive CAGE test (OR, 1.9949) were associated with failure of the intervention (P<.05). CONCLUSIONS: Counseling provided by the family doctor was highly effective under the usual conditions of general practice, both for patients with excessive alcohol consumption and for patients with con ADS.

Liver fibrosis assessment with semiquantitative indexes and image analysis quantification in sustained-responder and non-responder interferon-treated patients with chronic hepatitis C.

BACKGROUND/AIMS: The effect of interferon on the reduction of liver fibrosis is controversial. We aimed to compare semiquantitative methods with a quantitative digital image analysis system to assess liver fibrosis in biopsies from patients with chronic hepatitis and different responses to interferon. METHODS: We studied 98 liver biopsies with chronic hepatitis C before and after recombinant interferon alfa-2 treatment, using conventional histological assessment, grading of histological activity, scoring/staging of fibrosis (Knodell and Scheuer), and quantification of fibrosis with image analysis (FibroQuant). RESULTS: Sustained-responders to interferon showed a significant reduction in histological lesions and in their Knodell and Scheuer activity indexes. The semiquantitative systems showed no reduction in fibrosis. The FibroQuant application showed a significant reduction in porto-periportal and septal areas among sustained-responders (P < 0.001) and non-responders (P < 0.05), and in porto-periportal and septal fibrosis areas only in sustained-responders (P < 0.001), whereas the percentage of fibrosis increased in non-responders (P < 0.001). CONCLUSIONS: The Scheuer system is useful for the daily evaluation of fibrosis, but the FibroQuant application provides more objective data on the anti-fibrogenic effects of interferon, which include a reduction in the porto-periportal area in sustained-responders and non-responders, accompanied by a reduction in the area of fibrosis only when the viral replication has ceased.

[Validity and reliability of an instrument to assess the clinical interviews of residents in family and community medicine: the GATHA-RES questionnaire]. / Validez y fiabilidad de un instrumento para la valoración de la entrevista clínica en médicos residentes de medicina de familia: el cuestionario GATHA-RES.

OBJECTIVE: To check the validity of content, the internal consistency and the intra-observer reliability of a questionnaire to evaluate the doctor-patient communication of family medicine residents. DESIGN: Observation study, to validate a measurement instrument. SETTING: Primary care. Family and community medicine teaching units. STUDY POPULATION: For the validity analysis: 25 family and community medicine residents. For the reliability analysis: 48 doctors in the same speciality. MEASUREMENTS AND INTERVENTIONS: The questionnaire was constructed on the basis of a version (GATHA-BASE) composed of 42 items selected by a panel of 60 general practitioners. For content validity, 68 clinical encounters with simulated patients, video-recorded and evaluated, were used. The questionnaire's validity content was studied through a factorial analysis. To measure its internal consistency, Cronbach's alpha coefficients were calculated. Intra-observer reliability of the GATHA-RES version was evaluated through the kappa indexes and the intra-class correlation coefficients. RESULTS: We obtained a version of the GATHA-RES with 27 items. The factorial analysis revealed that there were 9 factors (<>, <>, <>, <>, <>, <>, <> and <>) which showed close correlation with the theoretical and formal contents of the original questionnaire (originally grouped in three sections: attitudes, communication tasks and skills). All the intraclass correlation coefficients had figures > or = 0.90. CONCLUSIONS: The GATHA-RES questionnaire is a valid and reliable instrument that can be used for evaluating the communication skills of general practitioners in training.

[Prevalence of physical activity in relation to variable socio-demographic conditions and life style in Cordoban students]. / Prevalencia de actividad física y su relación con variables sociodemográficas y ciertos estilos de vida en escolares Cordobeses.

BACKGROUND: Regular physical exercise is not a widespread habit among the population. Early childhood in a crucial stage for acquiring this habit. The objective of this study was that of ascertaining the behavior of school-age children with regard to the degree of physical activity they do and to examine the factors involved. METHODS: An observational study was conducted by means of a survey based on a questionnaire which 6th and 8th grade students in a Basic Health Care District of Cordoba (N-585) filled out on their own. Questions were asked regarding the frequency of exercise, preferences and prospects for practicing sports, the children's physical shape and school physical education classes, in addition to other behavior comprising their lifestyles. A dual-variable (p .05) and a multiple-variable analysis was conducted employing logistic regression. RESULTS: A total of 548 students filled out the survey (response rate = 97.8%). 79.3% (IC95% 75.7-82.6) were involved in extracurricular physical activities, 21.0% (IC95% 17.1-24.7%) being involved in intense physical exercise. 50.5% (IC95% 46.3-54.8) did not think that they were in good physical shape. The age, sex, type of residence, the involvement in sports on the part of their parents or a close friend and what they considered their degree of healthiness to be comprised the variables quite strongly linked to doing exercise (p .001). CONCLUSIONS: The prevalence of physical exercise is high, although it progressively decreased with age, especially for girls. A major number of students considered themselves to be in unsatisfactory physical condition.

[Tobacco consumption among the student population. Related factors]. / Consumo de tabaco entre la población escolar. Factores relacionados.

OBJECTIVE: To know smoking prevalence among schoolchildren and factors related with this habit. METHODS: A cross-sectional study. 548 school-children in their 6th and 8th years of primary studies at schools from an area of Córdoba (Spain) were interviewed. INTERVENTIONS: Autoadministered questionnaire. RESULTS: Tobacco was tried in 22% (CI 95%: 18.7-25.8) school-children. The average age for starting with this habit was 11.6 (SD)(CI 95%: 11.4-11.8). 12.1% smoked regularly and 1.3% smokers every day. The tobacco consumption in children was related with age (OR = 2.96; CI 95%: 1.12-7.82), cough medicines consumption (OR = 3.15; CI 95%: 1.32-7.48), to have a smokers sister (OR = 2.53; CI 95%: 1.06-6.00) and best friend (OR = 4.42; CI 95%: 1.85-10.60) and drinking beer (OR = 3.68; CI 95%: 1.15-11.7). CONCLUSIONS: The prevalence of smoking in our school-children is very close to that reported by others. Among the factors accounted with the tobacco consumption in schoolchildren, highlight the presence of this habit in the eldest sister and the best friend.

[Variables related to the self-perceived health status: a population study]. / Variables relacionadas con el estado de salud autopercibido: estudio poblacional.

OBJECTIVE: To study the self-perceived health status (PHS) of a community and its relationship to socio-economic variables of morbidity and frequency of attendance at the doctor's. DESIGN: A descriptive, crossover study. SETTING: A base Health District (HD). PATIENTS AND OTHER PARTICIPANTS: The general catchment area for the Occidente HD, Córdoba (N = 12,801 inhabitants) provided a random sample (for a p = 0.5, alpha error = 0.05 and with precision - 5%) of individuals over 15 (N = 384). MEASUREMENTS AND MAIN RESULTS: By means of a survey with a personal interview at home, socio-demographic data, PHS, chronic morbidity, consumption of pharmaceuticals and attendance at the doctor's were gathered. 32.9% (C.I. 95%: 27.4-37.1) stated a negative PHS. It was confirmed that older age (O.R. = 1.6; C.I. 1.04 - 1.08) and the existence of an acknowledged chronic pathology (O.R. = 6.84); C.I. 2.0 - 23.33) were the variables most strongly associated to a negative PHS. Chronic pathologies which were most intensely related to an unfavorable PHS were: Bronchitis (O.R. = 8.08; C.I. 3.02 - 21.5), Diabetes Mellitus (O.R. = 6.35; C.I., 1.03 - 38.9), Arthrosis (O.R. = 3.53; C.I. 2.03 - 6.13), Depression (O.R. = 3.53; C.I. 1.79 - 6.96), Arterial Hypertension (O.R. = 3.52; C.I. 1.63 - 7.63) and peptic ulcer (O.R. = 2.05; C.I. 1.02 - 4.11). CONCLUSIONS: The PHS could be useful as an overall indicator of the level of health of the population, as it is easy to obtain and has been shown to be linked to explanatory variables such as age and the presence of chronic disorders.

[Identification of problems and needs in health: description of a participative experience in primary care]. / Identificación de problemas y necesidades de salud: descripción de una experiencia participativa en atención primaria.

OBJECTIVE: To identify health problems and needs from a Health area population. To detect inequalities in relation with sociodemographic variables. METHODS: An observational descriptive study, cross-sectional study, qualitative research. SETTING: A Health area in Cordoba divided in three different areas: residential, inner city and rural area. We select three different groups of population and the following instruments of measurements: a) general population older than 15 years old (survey by interview completed door-to-door and personally) (N = 12,801) (coverage = 96.6%); b) Representatives of the community (N = 47), by Delphi technique (answering rate = 62.5%) and Nominal Group technique applied to participants in Health Councils (answering rate = 65.4%); c) Health workers (N = 45), by Delphi Process (answering rate = 58.5%). RESULTS: The people consider pains in their joints and allergies as the priority health problems, for the representatives of the community and the health workers the most important problems were dental hygiene and some chronic diseases. The needs detected as most important were, for the people from residential area, the lack of public gardens and cultural sites, for people from the inner city area it was the lack of public safety and in the rural area it was the lack of proper health resources. CONCLUSIONS: Although the different groups we study maintain a close agreement on what are the most important health problems and needs, we observed several interesting disagreement that could be explained by the different point of view that each group has on the process of health-disease, on perceiving problems and needs and on the sociodemographic differences among them.