A revisited history of cacao domestication in pre-Columbian times revealed by archaeogenomic approaches.

Humans have a long history of transporting and trading plants, contributing to the evolution of domesticated plants. Theobroma cacao originated in the Neotropics from South America. However, little is known about its domestication and use in these regions. In this study, ceramic residues from a large sample of pre-Columbian cultures from South and Central America were analyzed using archaeogenomic and biochemical approaches. Here we show, for the first time, the widespread use of cacao in South America out of its native Amazonian area of origin, extending back 5000 years, likely supported by cultural interactions between the Amazon and the Pacific coast. We observed that strong genetic mixing between geographically distant cacao populations occurred as early as the middle Holocene, in South America, driven by humans, favoring the adaptation of T. cacao to new environments. This complex history of cacao domestication is the basis of today's cacao tree populations and its knowledge can help us better manage their genetic resources.

Estrategias de tratamiento en la metástasis vertebral. Necesidad de comités multidisciplinarios desde la perspectiva del cirujano. Narración de la literatura / Treatment strategies in vertebral metastasis. Need for multidisciplinary committees from the perspective of the surgeon. Narration of literatura

Las mejoras en el diagnóstico y tratamiento del cáncer han mejorado la supervivencia. Secundariamente también aumenta el número de estos pacientes que presentan una metástasis vertebral y el número con alguna morbilidad en relación con estas metástasis. Fractura vertebral, compresión radicular o lesión medular causan un deterioro de su calidad de vida. El objetivo en el tratamiento de las mismas ha de ser el control del dolor, mantenimiento función neurológica y de la estabilidad vertebral, teniendo presente que en muchos casos será un tratamiento paliativo.El tratamiento de estas complicaciones presenta un enfoque multidisciplinario, radiólogos, radiólogos intervencionistas, oncólogos y radioterapeutas, cirujanos de raquis, pero también Unidad de Rehabilitación o Unidad de Dolor. Recientes trabajos muestran que un enfoque multidisciplinario de estos pacientes puede mejorar calidad de vida e incluso pronóstico.En el presente trabajo se realiza una revisión y lectura de la bibliografía sobre el manejo multidisciplinario de estos pacientes.(AU)

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increases. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life.The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment.The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis.In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.(AU)

[Translated article] Treatment strategies in vertebral metastasis. Need for multidisciplinary committees from the perspective of the surgeon. Narration of literature / Estrategias de tratamiento en la metástasis vertebral. Necesidad de comités multidisciplinarios desde la perspectiva del cirujano. Narración de la literatura

Las mejoras en el diagnóstico y tratamiento del cáncer han mejorado la supervivencia. Secundariamente también aumenta el número de estos pacientes que presentan una metástasis vertebral y el número con alguna morbilidad en relación con estas metástasis. Fractura vertebral, compresión radicular o lesión medular causan un deterioro de su calidad de vida. El objetivo en el tratamiento de las mismas ha de ser el control del dolor, mantenimiento función neurológica y de la estabilidad vertebral, teniendo presente que en muchos casos será un tratamiento paliativo.El tratamiento de estas complicaciones presenta un enfoque multidisciplinario, radiólogos, radiólogos intervencionistas, oncólogos y radioterapeutas, cirujanos de raquis, pero también Unidad de Rehabilitación o Unidad de Dolor. Recientes trabajos muestran que un enfoque multidisciplinario de estos pacientes puede mejorar calidad de vida e incluso pronóstico.En el presente trabajo se realiza una revisión y lectura de la bibliografía sobre el manejo multidisciplinario de estos pacientes.(AU)

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increases. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life.The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment.The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis.In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.(AU)

[Translated article] Treatment strategies in vertebral metastasis. Need for multidisciplinary committees from the perspective of the surgeon. Narration of literature.

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increase. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life. The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment. The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis. In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.

Treatment strategies in vertebral metastasis. Need for multidisciplinary committees from the perspective of the surgeon. Narration of literatura. / Estrategias de tratamiento en la metástasis vertebral. Necesidad de comités multidisciplinarios desde la perspectiva del cirujano. Narración de la literatura.

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increases. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life. The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment. The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis. In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.

Simulation in healthcare during COVID-19: An experience with residents in Anaesthesiology.

BACKGROUND: The restrictions to stop COVID-19 pandemic have had a negative impact in simulation, however, it is imperative to develop new strategies that facilitate healthcare education. OBJECTIVE: To describe a simulation in healthcare based on the learning of Non-Technical Skills (NTS) and performed under the restrictions of COVID-19 Pandemic. METHODS: Quasi-experimental study of an educational activity performed through simulation with anaesthesiology residents in November 2020. Twelve residents participated in two consecutive days. A questionnaire was filled related to the performance of NTS that encompasses leadership, teamwork and decision making. The complexity of the scenarios and the NTS results obtained between the two days were analysed. Advantages and challenges were documented when a clinical simulation is performed under COVID-19 restrictions. RESULTS: The global performance of the teams improved when comparing first and second day (79.5% vs 88.6%, p<0.01). Leadership was the worst section rated, however, was the one that showed the best improvement (70% vs 87.5%, p<0.01). The complexity of the simulation cases had no relation with the group performance in leadership and teamwork but affected task management results. General satisfaction was over 75%. The main challenges to develop the activity were the technology required to adapt virtuality to simulation and the time spent for the preparation of it. No cases of COVID-19 were reported within the first month after the activity. CONCLUSION: Clinical simulation can be done in the context of COVID-19 Pandemic, obtaining satisfactory learning results but requiring the adaptation of institutions to the new challenges it implies.

Simulación sanitaria durante la COVID-19: una experiencia con los residentes de Anestesiología / Simulation in healthcare during COVID-19: An experience with residents in Anaesthesiology

Antecedentes: Las restricciones para frenar la pandemia de COVID-19 han tenido un impacto negativo en la simulación. Sin embargo, es imperativo desarrollar nuevas estrategias para facilitar la educación sanitaria. Objetivo: Describir una simulación sanitaria basada en el aprendizaje de competencias no técnicas realizadas en el contexto de las restricciones de la pandemia de COVID-19. Métodos: Estudio cuasiexperimental de una actividad educativa realizada mediante simulación con residentes de Anestesiología en noviembre de 2020. Doce residentes participaron en 2 días consecutivos. Se completó un cuestionario relativo al desempeño de competencias no técnicas que abarcaba liderazgo, trabajo en equipo y toma de decisiones. Se analizaron la complejidad de los escenarios y los resultados de las competencias no técnicas, obtenidos entre los 2 días. Se documentaron las ventajas y dificultades de realizar una simulación clínica durante las restricciones de la COVID-19. Resultados: El desempeño global de los equipos mejoró al comparar el primero y segundo días (79,5 vs. 88,6%, p<0,01). El liderazgo fue la sección peor calificada, aunque, sin embargo, fue la que reflejó mayor mejora (70 vs. 87,5%, p<0,01). La complejidad de los casos de simulación no guardó relación con el desempeño del grupo en cuanto a liderazgo y trabajo en equipo, pero afectó a los resultados sobre gestión de tareas. La satisfacción general fue superior al 75%. Las principales dificultades para desarrollar la actividad fueron la tecnología necesaria para adaptar la virtualidad a la simulación y el tiempo empleado en su preparación. No se reportaron casos de COVID-19 durante el primer mes posterior a la actividad. Conclusión: La simulación clínica puede realizarse dentro del contexto de la pandemia de COVID-19, obteniéndose resultados satisfactorios de aprendizaje, pero requiriendo la adaptación de las instituciones a las nuevas dificultades que ello implica.(AU)

Background: The restrictions to stop COVID-19 pandemic have had a negative impact in simulation. However, it is imperative to develop new strategies that facilitate healthcare education.Objective: To describe a simulation in healthcare based on the learning of non-technical skills and performed under the restrictions of COVID-19 pandemic. Methods: Quasi-experimental study of an educational activity performed through simulation with Anaesthesiology residents in November 2020. Twelve residents participated in 2 consecutive days. A questionnaire was filled related to the performance of non-technical skills that encompasses leadership, teamwork and decision making. The complexity of the scenarios and the non-technical skills results obtained between the 2 days were analysed. Advantages and challenges were documented when a clinical simulation is performed under COVID-19 restrictions. Results: The global performance of the teams improved when comparing first and second day (79.5 vs. 88.6%, P<.01). Leadership was the worst section rated, however, was the one that showed the best improvement (70 vs. 87.5%, P<.01). The complexity of the simulation cases had no relation with the group performance in leadership and teamwork but affected task management results. General satisfaction was over 75%. The main challenges to develop the activity were the technology required to adapt virtuality to simulation and the time spent for the preparation of it. No cases of COVID-19 were reported within the first month after the activity. Conclusion: Clinical simulation can be done in the context of COVID-19 pandemic, obtaining satisfactory learning results but requiring the adaptation of institutions to the new challenges it implies.(AU)

[Simulation in healthcare during COVID-19: An experience with residents in Anaesthesiology]. / Simulación sanitaria durante la COVID-19: una experiencia con los residentes de Anestesiología.

Background: The restrictions to stop COVID-19 pandemic have had a negative impact in simulation. However, it is imperative to develop new strategies that facilitate healthcare education. Objective: To describe a simulation in healthcare based on the learning of non-technical skills and performed under the restrictions of COVID-19 pandemic. Methods: Quasi-experimental study of an educational activity performed through simulation with Anaesthesiology residents in November 2020. Twelve residents participated in 2 consecutive days. A questionnaire was filled related to the performance of non-technical skills that encompasses leadership, teamwork and decision making. The complexity of the scenarios and the non-technical skills results obtained between the 2 days were analysed. Advantages and challenges were documented when a clinical simulation is performed under COVID-19 restrictions. Results: The global performance of the teams improved when comparing first and second day (79.5 vs. 88.6%, P < .01). Leadership was the worst section rated, however, was the one that showed the best improvement (70 vs. 87.5%, P < .01). The complexity of the simulation cases had no relation with the group performance in leadership and teamwork but affected task management results. General satisfaction was over 75%. The main challenges to develop the activity were the technology required to adapt virtuality to simulation and the time spent for the preparation of it. No cases of COVID-19 were reported within the first month after the activity. Conclusion: Clinical simulation can be done in the context of COVID-19 pandemic, obtaining satisfactory learning results but requiring the adaptation of institutions to the new challenges it implies.

Optimización del modelo de abordaje a pacientes con asma en Atención Primaria en un entorno COVID-19 / Optimisation of the approach model for asthma patients in Primary Care in a COVID-19 setting

JUSTIFICACIÓN: el asma genera importante morbimortalidad. Una estrategia dirigida a optimizar el modelo de abordaje a pacientes con asma en Atención Primaria en un entorno COVID-19 puede mejorar los resultados en salud.OBJETIVO: crear un marco de actuación de referencia para mejorar el abordaje y satisfacer las necesidades de los pacientes asmáticos en un entorno COVID-19 en Atención Primaria.MATERIAL Y MÉTODOS: se revisó y rediseñó el modelo actual de abordaje de los pacientes adultos con asma en Atención Primaria, desde una perspectiva multidisciplinar, incorporando el concepto Asthma Right Care (1) y el impacto COVID-19.Pensamos que funcionaría por ser un proyecto desarrollado bajo el liderazgo clínico con un enfoque multidisciplinar . Estrategia para el cambio: entre septiembre 2020 - diciembre 2021: Creación de un comité científico. Análisis de la situación actual en 17 centros de salud de Atención Primaria de 7 comunidades autónomas españolas: Personal Médico de Familia, Enfermería y administrativo de cada Centro de Salud con farmacéuticos caracterizaron su modelo de abordaje del paciente asmático e identificaron áreas de mejora, acompañadas de planes de acción. Sesión grupal on line. Informe de resultados para cada centro, con propuesta de indicadores de evaluación de resultado. Laboratorio Digital de Innovación Nacional on line.14-12-2021Usando Mentimeter, referentes de los Centros de Salud y comité científico priorizaron las áreas de mejora identificadas y desarrollaron planes de acción para las dos áreas de mejora más prioritarias. Presentación Informe final del Laboratorio Digital. Impactos esperados• Identificación de áreas de mejora en los itinerarios del paciente asmático en un entorno COVID-19•Diseño participativo de planes de acción seguros y eficientes• Difundir el movimiento Asthma Right Care (AU)

Estudio de la expresión de factores óseos en el hueso murino ante la falta de pleiotrofina y sus cambios en la situación inflamatoria / Study of bone factor expression in murine model in the absence of pleiotrophin and its changes in the inflammatory situation

La pleitrofina (PTN) en un péptido implicado en el desarrollo y el mantenimiento del tejido óseo, y con importantes funciones en los procesos inflamatorios. Sin embargo, la deleción de la PTN en modelos murinos no produce un deterioro óseo significativo, sin que hasta la fecha se hayan estudiado los mecanismos que compensan su perdida. Con este estudio quisimos comprobar cómo afecta la deleción de PTN y la inflamación aguda a la expresión de factores óseos. Para ello empleamos ratones hembra de tres meses deficientes para la PTN (PTNKo) a las que indujimos una inflamación aguda por administración de lipopolisacárido (LPS). Se aislaron las vértebras y las tibias para poder medir la expresión de genes y realizar un recuento de osteocitos. En cultivos celulares comprobamos si la PTN podía proteger a células MC3T3 (osteoblásticas) y MLOY4 (osteocitos) de la inducción de muerte celular producida por etopósido. Nuestros resultados muestran que la expresión de osteocalcina está incrementada en las vértebras de los ratones PTNKo, y que la inflamación produjo el incremento de expresión de podaplanina (E11), conexina 43 (Cox43) y el péptido relacionado con la parathormona (PTHrP) en los ratones PTNKo tratados con LPS. La administración de PTN redujo de manera significativa la muerte inducida por etopósido en cultivos de células MC3T3 y MLOY4. En conclusión, la deficiencia de PTN indujo un aumento de la expresión de OCN, y la inflamación aguda produjo la sobrexpresión de E11, PTHrP, y Cox43 en ratones PTNKo. La PTN aumentó la viabilidad de células osteblásticas y osteocitos frente al tratamiento con etopósido

Pleiotrophin (PTN) is a peptide involved in the development and maintenance of bone tissue with important functions in inflammatory processes. However, the deletion of PTN in murine models does not produce a significant bone deterioration, but the mechanisms that compensate for its loss have not been studied to date. Our study was aimed at verifying how the deletion of PTN and acute inflammation affect the expression of bone factors. To this end, we used three-month-old female mice deficient for PTN (PTNKo) to which we induced acute inflammation by administration of lipopolysaccharide (LPS). Vertebrae and tibiae were isolated to measure gene expression and carry out an osteocyte count. In cell cultures, we checked whether PTN could protect MC3T3 (osteoblast) and MLOY4 (osteocyte) cells from the induction of cell death caused by etoposide. Our results show that the expression of osteocalcin is increased in the vertebrae of PTNKo mice, and that inflammation increased the expression of podhalanin (E11), connexin 43 (Cox43) and the parathormone-related peptide (PTHrP) in the PTNKo mice treated with LPS. Administering PTN significantly reduced etoposide-induced death in MC3T3 and MLOY4 cell cultures. Thus, PTN deficiency induced increased expression of OCN, and acute inflammation produced overexpression of E11, PTHrP, and Cox43 in PTNKo mice. PTN increased the viability of osteoblastic cells and osteocytes compared to etoposide treatment

Potential association of Trypanosoma cruzi DTUs TcV and TcVI with the digestive form of Chagas disease.

The relationship among genetic diversity of Trypanosoma cruzi and clinical forms of Chagas disease remain elusive. In order to assess the possible association between different T. cruzi Discrete Typing Units (DTUs) and the clinical pictures of the disease, 205 chronic patients from Salta province, Argentina, were analysed. One hundred and twenty-two of these patients were clinically categorized as: cardiac 38.5% (47/122), digestive 15% (18/122), cardio-digestive 16% (20/122) and asymptomatic 30% (37/122). From each patient, blood samples were taken for both, Polymerase Chain Reaction (PCR) targeting kDNA and blood culture analyses. The presence of T. cruzi kDNA was detected in 43% (88/205) of the patients. T. cruzi DTUs were identified in 74% (65/88) of the kDNA positive patients by PCR-hybridization using specific probes. We detected the presence of DTUs TcI, TcII, TcV and TcVI. Single infections (i.e. presence of only one DTU in the sample) were detected in 38.64% of the samples (34/88), while mixed infections were 35.23% (31/88). TcV was the most prevalent DTU (60.3%- 53/88). The association analyses showed, for the first time to the best of our knowledge, that TcV and TcVI were associated with the digestive form of Chagas Disease (Fisher p = .0001).

Effectiveness of an intervention in multicomponent exercise in primary care to improve frailty parameters in patients over 70 years of age (MEFAP-project), a randomised clinical trial: rationale and study design.

BACKGROUND: Physical activity may reverse frailty in the elderly, but we encounter barriers to the implementation of exercise programs in this population. Our main aim is to evaluate the effect of a multicomponent physical activity program, versus regular medical practice, on reverting pre-frailty status among the elderly, 12 months post-intervention. METHODS: Randomized parallel group multicenter clinical trial located in primary care setting, among non-dependent and pre-frail patients > 70 years old, including 190 patients (95 intervention, 95 control group). INTERVENTION: Multicomponent physical activity program (MEFAP, for its acronym in Spanish) with twelve 1.5 h-weekly sessions comprised of: 1. Informative session; 2. Exercises for improving aerobic resistance, muscle strength, propioception-balance and flexibility; and 3. Handing out of at-home exercise chart (twice/week). Main variable: pre-frailty according to the Fried phenotype. Secondary variables: sociodemographic, clinical and functional variables; exercise program adherence, patient satisfaction with the program and quality of life. We will perform an intention-to-treat analysis by comparing the retrogression from pre-frailty (1 or 2 Fried criteria) to robust status (0 Fried criteria) by the end of the intervention, 6 months and 12 months post-intervention. The accumulated incidence in each group will be calculated, as well as the relative risk (RR) and the number needed to treat (NNT) with their corresponding 95% confidence intervals. Protocol was approved by the Ethics Committee Hospital la Paz. DISCUSSION: Within the context of regular clinical practice, our results will provide evidence regarding the effects of exercise interventions on frailty among pre-frail older adults, a key population given their significant potential for functional, physical, and mental health improvement. TRIAL REGISTRATION: NCT03568084 . Registered 26 June 2018. Date of enrollment of the first participant to the trial: July 2nd 2018.

Acretismo placentario: un diagnóstico emergente. Abordaje quirúrgico no conservador / Placental accreta: an emerging diagnosis. Approach non-conservative surgical

RESUMEN El espectro de acretismo placentario es un fenómeno infrecuente del embarazo cuya incidencia ha aumentado considerablemente y que está caracterizado por el anclaje anormal de las vellosidades coriónicas al miometrio, lo cual aumenta la morbi-mortalidad materna durante la resolución quirúrgica. Según las capas uterinas comprometidas, serán clasificadas como placenta acreta (contacta miometrio), increta (penetra miometrio) y percreta (compromete todo el miometrio y/o eventualmente órganos adyacentes), siendo su mayor factor de riesgo: la cesárea anterior y la placenta previa. En este artículo se realizó una revisión bibliográfica abarcando definiciones, diagnóstico y las nuevas tendencias en manejo quirúrgico no conservador propuesto en la nueva guía de la Federación Internacional de Ginecología y Obstetricia publicada en 2018 y elaborando una discusión respecto a ellas.

SUMMARY Placenta accreta spectrum is an uncommon phenomenon of pregnancy whose incidence has increased considerably over time and is characterized by the abnormal anchoring of the chorionic villi to the myometrium, which increases maternal morbidity and mortality during surgical resolution. According to the compromised uterine layers, they will be classified as placenta accreta (contacts myometrium), increta (penetrates myometrium) and percreta (compromises the entire myometrium and / or possibly adjacent organs), being previous caesarean section and placenta previous its major risk factor. In this review, we included definitions, diagnosis, and the new topics in non-conservative surgical management developed by the International Federation of Obstetrics and Gynecolgy published in 2018, and developing a discussion of the topic.

Síndrome de Kounis o infarto alérgico: una entidad desconocida / Kounis syndrome or allergic infarction: a relatively unknown entity

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Analysis of soluble or titanium dioxide derived titanium levels in human whole blood: consensus from an inter-laboratory comparison.

Exposure to titanium (Ti), via the ingestion of pigment grade Ti dioxide (TiO2), is commonplace for westernised populations. It may also occur as a consequence of metal ion leaching in subjects bearing Ti-containing implants. Accurate exposure analysis requires fit-for-purpose analytical methodology, especially for true measures of baseline levels. Inductively coupled plasma (ICP) techniques are, mainly, now used for bio-analysis of Ti. Since whole blood reference materials, certified for natural low levels of Ti, are not currently available, we undertook an inter-laboratory comparison of pooled human blood from fasted volunteers ±low level (+∼2.5 µg L-1) or high level (+10-20 µg L-1) spikes of soluble Ti or TiO2 particles. Seven established laboratories were enrolled to analyse the samples using ICP based techniques, which included at least one of ICP optical emission spectrometry (ICP-OES), high resolution ICP mass spectrometry (HR-ICP-MS), triple quadrupole ICP-MS (ICP-MS/MS) or single quadrupole ICP-MS (SQ-ICP-MS). Five laboratories diluted the blood for analysis whilst two performed acid digestion. Overall, we showed that the laboratories could, mostly, quantitatively detect modest levels of spiked Ti in blood. Markedly varying levels of Ti, however, were reported for the same baseline pooled sample (0.4-24.6 µg L-1) and, in this study, specificity was poor for SQ-ICP-MS. Digestion of samples caused sample contamination compromising limits of detection and accuracy, whilst simple dilution had no such problem, and remained linear in response for spikes with ionic and TiO2 particles. We conclude that measuring baseline levels of Ti in whole blood is challenging but should be readily achievable down to 0.5-1.5 µg L-1, if sample preparation avoids contamination and instrument techniques are used that negate polyatomic or isobaric interferences from the sample matrix. We also remind those relying upon Ti bio-analytical data for their experimental outcomes that (a) spiking and recovery experiments provide information only on linearity of detection but not at all on accuracy as this will not detect constant positive errors and that (b) biological standard materials for Ti generally contain high levels of the analyte and tend to mask baseline analytical errors. Caution may be required in interpreting the findings of some published Ti/TiO2 bio-exposure studies.

Risk factors associated with drug use before imprisonment in Peru.

OBJECTIVE: To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru. MATERIALS AND METHODS: A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use. RESULTS: Out of a population of 76,180 prisoners, 71,184 (93.4%) answered the survey (men 67,071, 94.2%). The overall prevalence of drug consumption before admission was 24.4% (25.3 % in men and 9.1% in women), the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women). The most commonly used drugs were marijuana (58.2%), coca paste/cocaine or crack (40.3%) and inhalants (1%). The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%), history of previous imprisonment (59.1%), unemployment (48.4%), relationships at school with classmates who had problems with the law (46.9%), background of a family member who attended a penitentiary (38.4%), and history of running away from home before age 15 (35.9%). CONCLUSIONS: In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is important to consider these in the design of social and health policies focused on specific subpopulations to prevent drug use and crime.