Beyond cannabinoids: Application of NMR-based metabolomics for the assessment of Cannabis sativa L. crop health.

While Cannabis sativa L. varieties have been traditionally characterized by their major cannabinoid profile, it is now well established that other plant metabolites can also have physiological effects, including minor cannabinoids, terpenes, and flavonoids. Given the multiple applications of cannabis in the medical field, it is therefore critical to characterize it according to its chemical composition (i.e., its metabolome) and not only its botanical traits. With this in mind, the cannabinoid and metabolomic profiles from inflorescences of two C. sativa varieties with either high Δ9-tetrahydrocannabinolic acid (THCA) or high cannabidiolic acid (CBDA) contents harvested at different times were studied. According to results from HPLC and NMR-based untargeted metabolomic analyses of organic and aqueous plant material extracts, we show that in addition to expected variations according to cannabinoid profiles, it is possible to distinguish between harvests of the same variety. In particular, it was possible to correlate variations in the metabolome with presence of powdery mildew, leading to the identification of molecular markers associated with this fungal infection in C. sativa.

Cost-effectiveness of dexamethasone compared with aflibercept in naïve diabetic macular edema.

BACKGROUND: To assess the cost-effectiveness of the delayed-release device of dexamethasone compared with aflibercept in the treatment of patients with naïve diabetic macular edema (DME) from a societal perspective in the healthcare sector Zaragoza III in Spain. METHODS: A Markov model with five states defined by visual acuity (VA) in the better-seeing eye (Snellen scale) and an additional death state were constructed. Two cohorts of patients were distributed along the VA states and treated during a year with either dexamethasone or aflibercept. One-year follow-up on each group was performed. Medical costs related to the DME treatment and follow-up, medical costs related to the DME comorbidities, and non-medical-related costs were taken into account. Costs (2020 €), health outcomes (Quality-Adjusted Life Years-QALYs), both discounted at a 3.5% annual rate, and incremental cost-effectiveness ratios (ICER: €/QALY) were determined for a lifetime horizon in the base case analysis. RESULTS: Patients treated with dexamethasone were €77,349 more costly and provided 2.667 additional QALYs (€29,002/QALY) than those treated with aflibercept. The variable efficiency per patient was calculated dividing the improvement in quality of life (on the VFQ-25 scale) by the cost of the treatment. With the obtained results it can be concluded that the efficiency of treating the patients with dexamethasone is significantly superior than the efficiency of treating them with aflibercept. CONCLUSIONS: The cost per QALY gained with the delayed-release device of dexamethasone compared with the one obtained by aflibercept in the naïve DME population is just below the €30,000 threshold, below which, new drugs are sometimes regarded as cost-effective strategies in Spain. In this model, the key variables with greater impact on the cost-effectiveness results were the selected time horizon, the chosen extrapolation method and the number of aflibercept and dexamethasone injections.

Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology.

Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.

The Castilian Spanish version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR).

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Castilian Spanish language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability and construct validity (convergent and discriminant validity). A total of 526 JIA patients (8.6% systemic, 49.4% oligoarticular, 18.2% RF negative polyarthritis, 23.8% other categories) and 78 healthy children, were enrolled in six centres. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the Castilian Spanish version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practise and clinical research.

Situación de salud en asentamientos precarios / The health situation of precarious settlements

OBJETIVO: Conocer la situación de salud de los miembros del Campamento Manuel Bustos, en la región de Valparaíso, considerando sus características socioeconómicas y ambientales y la autopercepción del estado de salud. Material y MÉTODO: Se realizó una investigación cuantitativa, descriptiva y no experimental. Se aplicó un cuestionario a través de una entrevista semiestructurada a una muestra de 89 familias del campamento. RESULTADOS: Las familias del campamento se caracterizan principalmente por ser jóvenes, asistir a controles (principalmente el Niño Sano y EMPA), estar casi en su totalidad inscritos en un CESFAM. Las viviendas poseen irregular eliminación de excretas y un 40% de los hogares tiene algún miembro con hipertensión arterial. En promedio, los residentes valoran su estado de salud con nota 5 en una escala de 1 a 7.CONCLUSIÓN: Se observó que la situación de salud de los habitantes del campamento presenta aspectos positivos vinculados a la inscripción en CES-FAM y la asistencia a controles. No obstante, la alta presencia de hipertensión arterial, las precarias condiciones de eliminación de excretas y la presencia de basurales cercanos son factores de riesgo para la salud, que deberán ser atendidas por los organismos gubernamentales y no gubernamentales que trabajan en este territorio.

OBJECTIVE: To explore the health status of members of the Manuel Bustos Settlement, in the region of Valparaiso, in terms of socioeconomic and environmental characteristics and their self-perceived health status. MATERIAL AND METHODS: A descriptive and non-experimental quantitative study was conducted. A questionnaire was applied through semistructured interviews to 89 families in the settlement. RESULTS: Families of the settlement are characterized principally by their young age, for attending regular health appointments (mainly the Well Child check ups and preventative annual physical exam for adults), and, in the case of the majority, for being enrolled in a local community health center. Their houses have irregular human waste disposal and 40% of households have a member with hypertension. On average, the residents valued their health status with a grade of 5, on a scale from 1 to 7. CONCLUSIONS: The health situation of the inhabitants of the settlement presents positive as-pects related to health center enrollment and regular attendance of controls. However, the high prevalence of hypertension, the precarious conditions of eliminating human waste, and the pre-sence of nearby landfills are risk factors for health that must be addressed by government and nongovernmental organizations, which work in this territory.

Lithological and land-use based assessment of heavy metal pollution in soils surrounding a cement plant in SW Europe.

We study the influence of phasing out a cement plant on the heavy metal (Hg, Pb and Cr) content in the surrounding soils, taking into account factors often neglected, such as contributions due to local lithology or land use. The range of total Hg was 10-144µg kg(-1), reaching up to 41 and 145mgkg(-1) for total contents of Pb and Cr, respectively. Forest soils showed higher concentration of Hg than prairie soils, indicating the importance of land use on the accumulation of volatile heavy metals in soils. In forest soils, total Hg showed a trend to decrease with soil depth, whereas in prairie soils the vertical pattern of heavy metal concentrations was quite homogeneous. In most cases, the distance to the cement plant was not a factor of influence in the soils content of the analyzed heavy metals. Total Pb and Cr contents in soils nearby the cement plant were quite similar to those found in the local lithology, resulting in enrichment factor values (EF's) below 2. This suggests that soil parent material is the main source of these heavy metals in the studied soils, while the contribution of the cement plant to Pb and Cr soil pollution was almost negligible. On the contrary, the soils surrounding the cement plant accumulate a significant amount of Hg, compared to the underlying lithology. This was especially noticeable in forest soils, where Hg EF achieved values up to 36. These results are of relevance, bearing in mind that Hg accumulation in soils may be an issue of environmental concern, particularly in prairie soils, where temporal flooding can favor Hg transformation to highly toxic methyl-Hg. In addition, the concurrence of acid soils and total-Cr concentrations in the range of those considered phytotoxic should be also stressed.

[Development and assessment of EPInfant: a rating scale of perceived exertion for the pediatric population]. / Construcción y evaluación de Epinfant: una escala para la medición del esfuerzo percibido en la población pediátrica.

Rating scales of perceived exertion (PE) have been used to measure PE during exercise in the adult population with successful results. However, in children, it is necessary to develop adapted instruments due to their cognitive immaturity. The number of Spanish-language validated instruments for the pediatric population is scarce. Our objective was to develop a new PE rating scale. Research design was divided into three stages: development, content validity, and criterion validity. For development, a panel of five expert members was summoned, who provided indications for the new instrument. A systematic review of the literature to identify other validated instruments was performed. This process resulted in the development of the new EPInfant scale to measure PE, which integrates the expert panel's indications and the result of the literature systematic review. The evaluation of its content showed a high level of agreement regarding the quality of its design; the content validity index was 1. During the field assessment, a high concurrent criterion validity was observed in healthy adolescents due to the strong correlation shown between PE and heart rate in both boys and girls. The methodology used to develop the EPInfant scale aimed at reducing potential biases that may hinder its psychometric properties. Preliminary results suggest that this may be a validated instrument that could be implemented in healthy adolescents.

Las escalas de medición del esfuerzo percibido (EP) han sido utilizadas para cuantificar el EP en la población adulta durante el ejercicio, con resultados exitosos. No obstante, en niños, debido a su inmadurez cognitiva, es necesario el desarrollo de instrumentos adaptados. Son escasos los instrumentos validados en lenguaje español para la población pediátrica. El objetivo fue desarrollar una nueva escala de medición de EP. Se llevó a cabo un diseño de investigación dividido en tres etapas: construcción, validez de contenido y validez de criterio. Para la construcción, se constituyó un panel de cinco expertos, quienes generaron indicaciones para el nuevo instrumento, y se realizó una revisión sistemática de la literatura para identificar otros instrumentos validados. Este proceso dio origen a la nueva escala EPInfant para la medición de EP, la cual integra las indicaciones del panel de expertos y el resultado de la revisión sistemática de la literatura. En la evaluación de su contenido, se observó un alto nivel de acuerdo respecto a la calidad de su diseño, que presentó un índice de validez de contenido de 1. En la evaluación en terreno, se observó una alta validez de criterio concurrente en adolescentes sanos al presentar una fuerte correlación entre EP y frecuencia cardíaca en ambos sexos. La escala EPInfant fue desarrollada mediante una metodología que procuró disminuir los potenciales sesgos que pudiesen afectar sus propiedades psicométricas. Resultados preliminares sugieren que sería una herramienta válida para su aplicación en adolescentes sanos

Trends in hospital admissions for acute exacerbation of COPD in Spain from 2006 to 2010.

OBJECTIVE: We aim to analyze changes in incidence, comorbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) over a 5-year study period in Spain. METHODS: We selected all hospital admissions for AE-COPD between 2006 and 2010 from the National Hospital Discharge Database covering the entire population of Spain. RESULTS: We identified a total of 215,835 patients. Overall crude incidence had decreased from 2.9 to 2.4 exacerbations of COPD per 10,000 inhabitants from 2006 to 2010 (p < 0.001). In 2006, 17.9% of patients had a Charlson Index >2 and in 2010, the prevalence had increased to 25.0% (p < 0.001). Regarding to treatment, we detected a significant increase in the use of non-invasive ventilation from 2.1% in 2006 to 5.3% in 2010 (p < 0.001). The median LOHS was 7 days in 2006 and it remained stable until 2010. During the period studied, the mean cost per patient increased from 3747 to 4129 Euros. Multivariate analysis showed that incidence of hospitalizations for AE-COPD and IHM had significantly decreased from 2006 to 2010. CONCLUSIONS: The current study provides data indicating a decrease in incidence of hospital admissions for AE-COPD in Spain from 2006 to 2010 with concomitant reduction in IHM, despite increasing comorbidity during this period, with no variations in LOHS. The mean cost per patient has risen significantly.