Distribution of Main Bioactive Compounds from Saffron Species as a Function of Infusion Temperature and Time in an Oil/Water System.

Most research on saffron has focused on its composition and beneficial effects, while the culinary perspective to enhance its gastronomic potential remains unexplored. This study aims to define the transfer of the main compounds responsible for color, flavor, and aromatic properties, evaluating three critical variables: temperature (60 °C, 80 °C and 100 °C), infusion time (ranging from 10 to 30 min), and the composition of the medium (water, oil, and water/oil). Samples were analyzed using the LC-QTOF MS/MS and ISO 3632-1:2011 methods. The major compounds were crocins, including trans-crocin and picrocrocin. Among the flavonoids, kaempferol 3-O-sophoroside stands out. Regarding extraction conditions, crocins, glycoside flavonoids, and picrocrocin were enhanced in water, the former in 100% water and at low temperatures, while picrocrocin proved to be the most stable compound with extraction favored at high temperatures. The variable with the greatest incidence of picrocrocin isolation seemed to be the concentration of water since water/oil compositions reported higher concentrations. Safranal and kaempferol were enriched in the oil phase and at lower temperatures. This study provides a chemical interpretation for the appropriate gastronomic use of saffron according to its versatility. Finally, the determination of safranal using the ISO method did not correlate with that obtained using chromatography.

Evolution of economic burden of heart failure by ejection fraction in newly diagnosed patients in Spain.

OBJECTIVE: To describe healthcare resource utilization (HCRU) and costs, in patients with newly diagnosed heart failure (HF) according to ejection fraction (EF) in Spain. METHODS: Retrospective cohort study that analyzed anonymized, integrated and computerised medical records in Spain. Patients with ≥ 1 new HF diagnosis between January 2013 and September 2019 were included and followed-up during a 4-year period. Rates per 100 person-years of HCRU and costs were estimated. RESULTS: Nineteen thousand nine hundred sixty-one patients were included, of whom 43.5%, 26.3%, 5.1% and 25.1% had HF with reduced, preserved, mildly reduced and unknown EF, respectively. From year 1 to 4, HF rates of outpatient visits decreased from 1149.5 (95% CI 1140.8-1159.3) to 765.5 (95% CI 745.9-784.5) and hospitalizations from 61.7 (95% CI 60.9-62.7) to 15.7(14.7-16.7) per 100 person-years. The majority of HF-related healthcare resource costs per patient were due to hospitalizations (year 1-4: 63.3-38.2%), followed by indirect costs (year 1-4: 12.2-29.0%), pharmacy (year 1-4: 11.9-19.9%), and outpatient care (year 1-4: 12.6-12.9%). Mean (SD) per patient HF-related costs decreased from 2509.6 (3518.5) to 1234.6 (1534.1) Euros (50% cost reduction). At baseline, 70.1% were taking beta-blockers, 56.3% renin-angiotensin system inhibitors, 11.8% mineralocorticoid receptor antagonists and 8.9% SGLT2 inhibitors. At 12 months, these numbers were 72.3%, 65.4%, 18.9% and 9.8%, respectively. CONCLUSIONS: Although the economic burden of HF decreased over time since diagnosis, it is still substantial. This reduction could be partially related to a survival bias (sick patients died early), but also to a better HF management. Despite that, there is still much room for improvement.

Antifungal activity screening of fractions from Annona cherimola Mill. leaf extract against Fusarium oxysporum.

The antifungal effect of ethanolic extract fractions of Annona cherimola leaves against the mycelial growth of Fusarium oxysporum was studied. The ethanolic crude extract was solvent partitioned and the ethyl acetate phase was fractionated by column or preparative thin-layer chromatography. All fractions were developed on TLC and analyzed for acetogenins (ACG) with Kedde reagent. The antifungal effect assays were carried out in vitro by the diffusion method on PDA plates. The ethanolic extract of A. cherimola leaves was highly active against F. oxysporum growth; subfractions obtained from the antifungal screening had a significant effect (p < 0.05) on the F. oxysporum growth parameters. The screening showed that as the purification steps progressed, the inhibition of mycelial growth increased. Six bioactive ACG (Annomolon-B, 34-epi annomolon B, almunequin, cherimoline 1, cherimoline 2, and isocherimoline 1) were identified by LC-QTOF-MS/MS. These findings suggested that bioactive ACG from A. cherimola leaves could be an alternative resource of a promising botanical fungicide to control plant diseases caused by F. oxysporum.

Red yeast rice for dyslipidaemias and cardiovascular risk reduction: A position paper of the International Lipid Expert Panel.

The risk of atherosclerotic cardiovascular disease (ASCVD) is strongly related to lifetime exposure to low-density lipoprotein (LDL)-cholesterol in longitudinal studies. Lipid-lowering therapy (using statins, ezetimibe and PCSK9 inhibitors) substantially ameliorates the risk and is associated with long-term reduction in cardiovascular (CV) events. The robust evidence supporting these therapies supports their continued (and expanding) role in risk reduction. In addition to these 'conventional' therapeutics, while waiting for other innovative therapies, growing evidence supports the use of a range of 'nutraceuticals' (constituents of food prepared as pharmaceutical formulations) including preparations of red yeast rice (RYR), the product of yeast (Monascus purpureus) grown on rice, which is a constituent of food and is used in traditional Chinese medicine. The major active ingredient, monacolin K, is chemically identical to lovastatin. RYR preparations have been demonstrated to be safe and effective in reducing LDL-C, and CV events. However, surprisingly, RYR has received relatively little attention in international guidelines - and conventional drugs with the strongest evidence for event reduction should always be preferred in clinical practice. Nevertheless, the absence of recommendations relating to RYR may preclude the use of a product which may have clinical utility in particular groups of patients (who may anyway self-prescribe this product), what in the consequence might help to reduce population CV risk. This Position Paper of the International Lipid Expert Panel (ILEP) will use the best available evidence to give advice on the use of red-yeast rice in clinical practice.

Effect of excise tax on sugar-sweetened beverages in Catalonia, Spain, three and a half years after its introduction.

BACKGROUND: The World Health Organisation urges countries to levy specific excise taxes on SSBs. Currently, more than 50 countries have introduced some type of tax on SSBs. In March 2017, the Autonomous Region of Catalonia approved the introduction of a tiered excise tax on SSBs for public health reasons. To evaluate the effect of the Catalonian excise tax on the price and purchase of sugar-sweetened beverages (SSBs) and their possible substitutes, i.e., non-sugar-sweetened beverages (NSSBs) and bottled water, three and half years after its introduction, and 1 year after the outbreak of the COVID-19 pandemic. METHODS: We analysed purchase data on soft drinks, fruit drinks and water, sourced from the Ministry of Agriculture food-consumption panel, in a random sample of 12,500 households across Spain. We applied the synthetic control method to infer the causal impact of the intervention, based on a Bayesian structural time-series model which predicts the counterfactual response that would have occurred in Catalonia, had no intervention taken place. RESULTS: As compared to the predicted (counterfactual) response, per capita purchases of SSBs fell by 0.17 l three and a half years after implementing the SSB tax in Catalonia, a 16.7% decline (95% CI: - 23.18, - 8.74). The mean SSB price rose by 0.11 €/L, an 11% increase (95% CI: 9.0, 14.1). Although there were no changes in mean NSSB prices, NSSB consumption rose by 0.19 l per capita, a 21.7% increase (95% CI: 18.25, 25.54). There were no variations in the price or consumption of bottled water. The effects were progressively greater over time, with SSB purchases decreasing by 10.4% at 1 year, 12.3% at 2 years, 15.3% at 3 years, and 16.7% at three and a half years of the tax's introduction. CONCLUSIONS: The Catalonian SSB excise tax had a sustained and progressive impact over time, with a fall in consumption of as much as 16.7% three and half years after its introduction. The observed NSSB substitution effect should be borne in mind when considering the application of this type of tax to the rest of Spain.

Food availability and affordability in a Mediterranean urban context: associations by store type and area-level socio-economic status.

OBJECTIVE: Although food environments have been highlighted as potentially effective targets to improve population diets, evidence on Mediterranean food environments is lacking. We examined differences in food availability and affordability in Madrid (Spain) by store type and area-level socio-economic status (SES). DESIGN: Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool to measure the availability and price of twelve food groups (specific foods = 35). We computed NEMS-S-MED scores and summarised price data with a Relative Price Index (RPI, comparing prices across stores) and an Affordability Index (normalising prices by area-level income). We compared the availability and affordability of 'healthier-less healthy' food pairs, scores between food store types (supermarkets, specialised, convenience stores and others) and area-level SES using ANOVA and multi-level regression models. SETTING: City of Madrid. 2016 and 2019 to cover a representative sample. PARTICIPANTS: Food stores within a socio-economically diverse sample of sixty-three census tracts (n 151). RESULTS: Supermarkets had higher food availability (37·5/49 NEMS-S-MED points), compared to convenience stores (13·5/49) and specialised stores (8/49). Supermarkets offered lower prices (RPI: 0·83) than specialised stores (RPI: 0·97) and convenience stores (RPI: 2·06). Both 'healthy' and 'less healthy' items were more available in supermarkets. We found no differences in food availability or price by area-level SES, but affordability was higher in higher-income areas. CONCLUSIONS: Supermarkets offered higher food availability and affordability for healthy and less healthy food items. Promoting healthy food availability through supermarkets and specialised stores and/or limiting access to convenience stores are promising policy options to achieve a healthier food environment.

Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study.

BACKGROUND: The objective of this study was to carry out a cost-effectiveness analysis of dapagliflozin, as an add-on therapy to standard of care (SoC), for the treatment of type 2 diabetes mellitus (T2DM) in Spain, based on the results of the DECLARE-TIMI 58 trial. METHODS: A discrete event simulation model (Cardiff T2DM) based on the data observed in the DECLARE-TIMI 58 trial was adapted to the Spanish setting to estimate the costs and health outcomes of treatment with dapagliflozin in patients with T2DM who had or were at risk of atherosclerotic cardiovascular disease. Macrovascular events (hospitalization for heart failure, myocardial infarction, stroke, and unstable angina), end-stage renal disease and cardiovascular and non-cardiovascular mortality were modeled according to the survival equations of the DECLARE-TIMI 58 study. Microvascular events (blindness and ulcers) were estimated based on the risk equations of the UK Prospective Diabetes Study. The analysis was conducted from the Spanish National Health System perspective and the time horizon was 30 years. The results were evaluated in terms of cost per quality-adjusted life year (QALY) gained. Only direct health costs were included, and a 3% discount rate was applied to costs and health outcomes. Univariate and probabilistic sensitivity analyses (PSA) were made to assess the robustness of the results. RESULTS: In the main analysis, dapagliflozin was a dominant therapeutic option compared with placebo, with greater effectiveness (0.08 QALYs) and lower associated total costs per patient (€ -2,921). The univariate sensitivity analysis and the PSA confirmed the robustness of the results. The PSA showed the probability that dapagliflozin was a dominant alternative compared with placebo was 84.2% and that it was cost-effective of 92.1%, under a willingness-to-pay of € 20,000/QALY gained. CONCLUSIONS: The analysis of data from the DECLARE-TIMI 58 trial shows that dapagliflozin would be a cost-effective option in Spain for the treatment of adult patients with T2DM, as an add-on therapy to SoC, compared with placebo.

Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain.

AIMS: To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain.  METHODS: Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identified through the BIG-PAC database. Rate per 100 person-years of all-cause and HF-related HCRU during the year after the index date were estimated using bootstrapping with replacement. RESULTS: Twenty-one thousand two hundred ninety-seven patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9-27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients. CONCLUSIONS: HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden.

Prognosis patients with COVID-19 using deep learning.

BACKGROUND: The coronavirus (COVID-19) is a novel pandemic and recently we do not have enough knowledge about the virus behaviour and key performance indicators (KPIs) to assess the mortality risk forecast. However, using a lot of complex and expensive biomarkers could be impossible for many low budget hospitals. Timely identification of the risk of mortality of COVID-19 patients (RMCPs) is essential to improve hospitals' management systems and resource allocation standards. METHODS: For the mortality risk prediction, this research work proposes a COVID-19 mortality risk calculator based on a deep learning (DL) model and based on a dataset provided by the HM Hospitals Madrid, Spain. A pre-processing strategy for unbalanced classes and feature selection is proposed. To evaluate the proposed methods, an over-sampling Synthetic Minority TEchnique (SMOTE) and data imputation approaches are introduced which is based on the K-nearest neighbour. RESULTS: A total of 1,503 seriously ill COVID-19 patients having a median age of 70 years old are comprised in the research work, with 927 (61.7%) males and 576 (38.3%) females. A total of 48 features are considered to evaluate the proposed method, and the following results are achieved. It includes the following values i.e., area under the curve (AUC) 0.93, F2 score 0.93, recall 1.00, accuracy, 0.95, precision 0.91, specificity 0.9279 and maximum probability of correct decision (MPCD) 0.93. CONCLUSION: The results show that the proposed method is significantly best for the mortality risk prediction of patients with COVID-19 infection. The MPCD score shows that the proposed DL outperforms on every dataset when evaluating even with an over-sampling technique. The benefits of the data imputation algorithm for unavailable biomarker data are also evaluated. Based on the results, the proposed scheme could be an appropriate tool for critically ill Covid-19 patients to assess the risk of mortality and prognosis.

SGLT2 inhibitors and GLP1 agonists administered without metformin compared to other glucose-lowering drugs in patients with type 2 diabetes mellitus to prevent cardiovascular events: A systematic review.

OBJECTIVES: To assess the efficacy of glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose co-transporter 2 (SGLT2) inhibitors, administered without metformin on cardiovascular outcomes in type 2 diabetes patients. METHODS: A systematic review was performed according to Cochrane's methodological standards. We included randomized clinical trials (RCTs) on adult type 2 diabetes patients, assessing the efficacy of SGLT2 inhibitors and GLP1-RAs compared to other glucose-lowering drugs and/or RCTs that presented data of a subgroup of type 2 diabetes patients without metformin use at baseline. The main outcome was the reduction of the risk of any major adverse cardiovascular events (MACE) reported individually or as a composite outcome. RESULTS: Five RCTs including 50,725 type 2 diabetes patients, of whom 10,013 had not received metformin, were included in this meta-analysis. Three of these studies assessed the efficacy of GLP1-RAs and two of SGLT2 inhibitors. In patients without metformin at baseline, GLP1-RAs in comparison with placebo reduced the risk of MACE significantly by 20% (HR: 0.80; 95% CI: 0.71-0.89). SGLT2 inhibitors also significantly reduced the risk of MACE by 32% (HR: 0.68; 95% CI: 0.57-0.81). CONCLUSIONS: SGLT2 inhibitors and GLP1-RAs provided without metformin at baseline may reduce the risk of MACE in comparison with placebo in type 2 diabetes patients at increased risk of cardiovascular events.

Changing paradigms: from prevention of thromboembolic events to improved survival in patients with atrial fibrillation.

Atrial fibrillation is associated with a five-fold increase in the risk of stroke. Current guidelines recommend the use of the CHA2DS2-VASc score to stratify the risk of stroke. In addition, guidelines recommend the identification of the conditions that increase the risk of haemorrhage to be modified and thus decrease the risk of bleeding. Nevertheless, many patients with a high thromboembolic risk are prescribed antiplatelet treatment or do not receive any antithrombotic therapy. In addition, therapeutic inertia is common in anticoagulated patients taking vitamin K antagonists, and underdosing is an emerging problem with direct oral anticoagulants, probably because many physicians consider the risk of stroke and the risk of major bleeding to be equal. It is necessary to develop a new approach to risk stratification, an approach that moves from morbidity to mortality, i.e., from stratification of the risk of stroke and major bleeding to stratification of the risk of mortality associated with stroke and the risk of mortality associated with bleeding. In this article, we propose a novel risk stratification approach based on the mortality associated with stroke and bleeding, illustrated by data derived from the literature.

Effect of health-promoting messages in television food commercials on adolescents' attitudes and consumption: A randomized intervention study.

INTRODUCTION: The HAVISA plan is a Spanish government's policy for the promotion of healthy lifestyles via health messages in television food advertisements. This study evaluated the positive or negative impact (health halo effect) of health messages on food choices and predisposition towards healthy habits of Spanish adolescents. METHODS: Randomized controlled study in 11-14 years old adolescents. The intervention group watched television advertisements for unhealthy foods with HAVISA health messages, while the control group watched the same advertisements without them. A self-administered questionnaire measured participants' attitudes towards the products advertised, to diet and physical activity, and recognition of messages. Afterwards they chose between fruit and unhealthy snacks. The differences between the two groups were then compared. RESULTS: A total of 27.2% of the control group versus 29.6% of the intervention group chose fruit (p = 0.54). Both groups displayed high desire for (7.24 vs. 7.40, p = 0.29) and intention to consume (6.67 vs. 6.73, p = 0.63) the unhealthy products advertised. There were no differences in perceived healthiness of these foods (4.11 vs. 4.19, p = 0.74), or perceived importance of a healthy diet (3.17 vs. 3.12, p = 0.55) or physical activity (4.53 vs. 4.51, p = 0.73). Desire for vegetables (2.49 vs. 2.66, p = 0.08) and fruit (3.15 vs. 3.30, p = 0.09) were higher in the intervention group, but the differences were not significant. Only 47.6% of participants noticed the presence of health messages; of these, 31% correctly recalled their content. CONCLUSION: HAVISA health messages changed neither the attitudes nor immediate eating behaviors of adolescents. There was no immediate healthy-lifestyle promoter or adverse health halo effect, probably due to the messages' low prominence. Further research should evaluate the long-term effect of repeated exposure to health messages.

Costs and healthcare utilisation of patients with chronic kidney disease in Spain.

BACKGROUND: Data about the impact of chronic kidney disease (CKD) on health care costs in Spain are scarce This study was aimed to evaluate cumulative costs and healthcare utilisation in CKD in Spain. METHODS: Observational, retrospective, population-based study, which included adults who received care for CKD between 2015 and 2019. Healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. RESULTS: We identified 44,214 patients with CKD (year 2015: age 76.4 ± 14.3 years, 49.0% women, albumin-to-creatinine ratio 362.9 ± 176.8 mg/g, estimated glomerular filtration rate 48.7 ± 13.2 mL/min/1.73 m2). During the 2015-2019 period, cumulative CKD associated costs reached 14,728.4 Euros, being cardiovascular disease hospitalizations, particularly due to heart failure and CKD, responsible for 77.1% of costs. Total medication cost accounted for 6.6% of the total cost. There was a progressive decrease in cardiovascular disease hospital costs per year (from 2741.1 Euros in 2015 to 1.971.7 Euros in 2019). This also occurred with cardiovascular and diabetic medication costs, as well as with the proportion of hospitalizations and mortality. Costs and healthcare resources use were higher in the DAPA-CKD like population, but also decreased over time. CONCLUSIONS: Between 2015 and 2019, costs of patients with CKD in Spain were high, with cardiovascular hospitalizations as the key determinant. Medication costs were responsible for only a small proportion of total CKD costs. Improving CKD management, particularly with the use of cardiovascular and renal protective medications may be helpful to reduce CKD burden.

A rare case of bilateral occipital condyle fractures associated with inferior clivus separation fracture resulting in craniocervical dislocation: a case report and modification of the Anderson and Montesano classification is proposed.

The authors report a very rare case of bilateral occipital condyle fractures (OCF) that was associated with complete separation fracture of the inferior clivus resulting in craniocervical dislocation alongside dissociation of C1-C2 joint complex. Also, a new type of the Anderson and Montesano classification system is presented with two subtypes of injuries. Type IVA occurs when the OCF is associated a clivus avulsion fracture, while Type IVB occurs when the OCF is associated with complete "en piece" separation fracture of the inferior clivus. Both Type IV injuries are considered highly unstable, and surgical fixation is the recommended treatment option.

Hyperbaric oxygen therapy for hypoxic-ischemic encephalopathy in non-fatal drowning.

Paroxysmal autonomic instability syndrome with dystonia (PAISD) is a possible complication that worsens the prognosis of hypoxic-ischemic encephalopathy related to non-fatal drowning. There are case reports of hyperbaric oxygen (HBO2) therapy enhancing recovery in such cases. We report a case of a 5-year-old boy admitted to the Pediatric Intensive Care Unit after a non-fatal drowning. He was transferred under mechanical ventilation and sedation, with hemodynamic instability and hypothermia. On admission he had a Glasgow Coma Score of 6. On the fifth day of admission he presented episodes of dystonia with decerebration posture, diaphoresis, tachycardia and hypertension, sometimes with identified triggers, suggesting PAISD. The episodes were difficult to control; multiple drugs were needed. Electroencephalography showed diffuse slow wave activity, and cranioencephalic magnetic resonance imaging showed hypoxia-related lesions, suggesting hypoxic-ischemic encephalopathy. Early after admission the patient started physiotherapy combined with normobaric oxygen therapy. Subsequently he started HBO2 therapy at 2 atmospheres, with a total of 66 sessions. Dystonia progressively subsided, with gradual discontinuation of therapy. He also showed improvement in spasticity, non-verbal communication and cephalic control. This case highlights the diagnostic and therapeutic challenges of PAISD and the potential benefit of HBO2 therapy, even in the subacute phase, in recovery of hypoxic-ischemic encephalopathy.

Influence of the fatty acid profile on the volatile components of virgin olive oil subjected to thermal stress.

BACKGROUND: Virgin olive oil (VOO) is greatly appreciated for its organoleptic features, which can be ascribed mainly to the presence of very chemically diverse volatile components. It is well known that the VOO volatile fraction depends strongly on different aspects, which encompass genetic, agronomic, processing, and post-processing factors. In this research, we developed a method for the qualitative and semiquantitative determination of volatile components in VOOs subjected to thermal stress by headspace extraction online coupled to gas chromatography-mass spectrometry (HS-GC-MS). RESULTS: The method was applied to 100 extra-virgin olive oil (EVOO) samples, which led to the tentative identification of 52 volatile components, including 12 alcohols, 17 aldehydes, three ketones, one ether, two furans, two carboxylic acids, and 15 hydrocarbons. The method was used to study the cultivar effect and the main biochemical pathways involved in the synthesis of volatile compounds, with special emphasis on those formed by degradation of unsaturated fatty acids (FAs). Principal component analysis (PCA), explaining 76.7% of the total variability, showed that the volatile profile of EVOOs subjected to thermal stress allowed discriminating samples from different cultivars. CONCLUSION: Volatiles detected in EVOOs subjected to thermal stress with the highest contribution to discrimination between the selected cultivars were correlated with the concentration of the three main FAs in VOO, namely oleic, linoleic, and linolenic acids. The FA profile seems to be especially relevant to explain the concentration of certain volatile compounds with direct incidence on the organoleptic properties. © 2021 Society of Chemical Industry.

Costs and healthcare utilisation of patients with heart failure in Spain.

BACKGROUND: Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. METHODS: Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. RESULTS: We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs. CONCLUSIONS: During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.

Impact of an excise tax on the consumption of sugar-sweetened beverages in young people living in poorer neighbourhoods of Catalonia, Spain: a difference in differences study.

BACKGROUND: Sugar-sweetened beverage consumption is contributing to the obesity epidemic. On 28 March 2017, Catalonia enacted a law levying an excise tax on sugar-sweetened beverages for public health reasons. The purpose of this study is to assess the impact of the tax on the consumption of sugar-sweetened beverages in Catalonia (Spain). METHODS: Before-and-after study to assess changes in the prevalence of consumption of sugar-sweetened beverages among 1929 persons aged 12 to 40 years residing in low-income neighbourhoods of Barcelona (intervention) and Madrid (control). Beverage consumption frequency was ascertained via a validated questionnaire administered during the month prior to the tax's introduction (May 2017) and again at 1 year after it had come into force. The effect of the tax was obtained using Poisson regression models with robust variance weighted using propensity scores. RESULTS: While the prevalence of regular consumers of taxed beverages fell by 39% in Barcelona as compared to Madrid, the prevalence of consumers of untaxed beverages remained stable. The main reason cited by more than two-thirds of those surveyed for reducing their consumption of sugar-sweetened beverages was the increase in price, followed by a heightened awareness of their health effects. CONCLUSIONS: The introduction of the Catalonian excise tax on sugar-sweetened beverages was followed by a reduction in the prevalence of regular consumers of taxed beverages.

GC-MS study of changes in polar/mid-polar and volatile compounds in Persian lime (Citrus latifolia) during fruit growth.

BACKGROUND: Citrus fruits possess a high content of bioactive compounds whose changes during fruit maturation have not been studied in depth. Fruits were sampled from week 1, after fruit onset (7 days after flowering), to week 14. Volatile compounds isolated by headspace-solid-phase microextraction and polar extracts from all samples were analyzed by gas chromatography-mass spectrometry. RESULTS: The relative abundance of 107 identified metabolites allowed differences among samples at different stages of fruit growth to be established. Principal component analysis showed a clear discrimination among samples, and analysis of variance revealed significant differences in 94 out of the 107 metabolites. Among total volatiles, monoterpenes increased their relative abundance from 86% to 94% during fruit growth, d-limonene, γ-terpinene and ß-pinene being the most abundant; conversely, sesquiterpenes decreased from 11.5% to 2.8%, ß-bisabolene and α-bergamotene being the most concentrated. Sugars, in general, exhibited a gradual increase in abundance, reaching a maximum between weeks 9 and 12. Citric and malic acids, representing approximately 90% of the total identified carboxylic acids, reached a maximum concentration at commercial maturity (week 14). CONCLUSION: Of the 107 tentatively identified metabolites during Persian lime growth, sugars, carboxylic acids, and volatiles were those that experienced more significant changes and more clearly created differences among fruit growth stages. © 2018 Society of Chemical Industry.

Essential Care for Every Baby: improving compliance with newborn care practices in rural Nicaragua.

BACKGROUND: Neonatal mortality comprises an increasing proportion of childhood deaths in the developing world. Essential newborn care practices as recommended by the WHO may improve neonatal outcomes in resource limited settings. Our objective was to pilot a Helping Babies Breathe and Essential Care for Every Baby (HBB and ECEB) implementation package using HBB-ECEB training combined with supportive supervision in rural Nicaragua. METHODS: We employed an HBB-ECEB implementation package in El Ayote and Santo Domingo, two rural municipalities in Nicaragua and used a pre- and post- data collection design for comparison. Following a period of pre-intervention data collection (June-August 2015), care providers were trained in HBB and ECEB using a train-the- trainer model. An external supportive supervisor monitored processes of care and collected data. Data on newborn care processes and short-term outcomes such as hypothermia were collected from facility medical records and analyzed using standard run charts. Home visits were used to determine breastfeeding rates at 7, 30 and 60 days. RESULTS: There were 480 institutional births during the study period (June 2015-June 2016). Following the HBB-ECEB implementation package, cord care improved (pre-intervention median 66%; post-intervention shift to ≥85%) and early skin-to-skin care improved (pre-intervention median 0%; post-intervention shift to ≥56%, with a high of 92% in June 2016). Rates of administration of ophthalmic ointment and vitamin K were high pre-intervention (median 97%) and remained high. Early initiation of breastfeeding increased with a pre-intervention median of 25% and post-intervention shift to ≥28%, with a peak of 81% in June 2016. Exclusive breastfeeding rates increased short-term but were not significantly different by 60-days of life (9% pre-intervention versus 21% post-intervention). CONCLUSIONS: The implementation of the HBB-ECEB programs combined with supportive supervision improved the quality of care for newborns in terms of cord care, early skin-to-skin care and early initiation of breastfeeding. The rates of administration of ophthalmic ointment and vitamin K were high pre- intervention and remained high afterwards. These findings show that HBB-ECEB programs implemented with supportive supervision can improve quality of care for newborns.