These findings suggest that at PDAI ≥ 7, every incremental increase in PDAI had a smaller detrimental impact on QoL. For the ABSIS, there was no significant difference in slopes before and after a given score, along with a higher P-value overall. Our results support previous findings 6 that the PDAI is superior to the ABSIS at capturing disease severity, especially at the lower end of disease activity (Figure 1c,d).To significantly improve QoL for patients with mucosal and nonmucosal PV, complete disease clearance may be necessary. Small amounts of worsening activity have an increasingly significant impact on QoL at the lower end of the spectrum. Above mild levels of activity, increasing activity has linear but detrimental smaller effects on QoL. The findings for patients with mucosal PV further support this, likely because oral erosions are painful and impact eating. Consistent with prior findings, 2 the Skindex-S best correlates with PDAI score in all patients.A notable limitation of this study is that our population had milder disease, with a median PDAI of 6Á75 and ABSIS of 11Á75. However, we are still able to show a change in QoL as the PDAI decreases, even at lower PDAI levels. Our findings have important clinical implications in determining appropriate outcomes for therapies. 7 Unlike dermatomyositis and systemic lupus erythematosus, 4 in patients with PV, complete clearance should be the goal.

Consistent participation and case entry confirm that a voluntary state-based hospital QI collaborative is feasible and sustainable. This occurred in the absence of continued hospital funding. Further research is needed to identify the relationship between program participation and improved patient care and the generalizability of the model.

IMPORTANCEAs public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico.OBJECTIVE To estimate the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria in 2017. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used data from 2 previous cross-sectional studies, including the pre-Hurricane Maria Puerto Rico Assessment on Diet, Lifestyles

Background: A single-item self-rated diet measure (SRD) may provide a quick, low-burden screener. However, assessment of its validity is limited. This study aimed to evaluate the association of an SRD construct with measured diet quality among adults in Puerto Rico (PR).Methodology: Participants (30–75 years old; n = 247) of the PR Assessment of Diet, Lifestyle, and Diseases (PRADLAD) cross-sectional study reported SRD with a single question (“How would you describe your current dietary habits and diet quality?”) with a five-point scale: excellent to poor. More complete diet quality was calculated using the Alternate Healthy Eating Index-2010 (AHEI), with 11 food and nutrient components assessed by the food frequency questionnaire. Multivariable general linear models were used to test associations between SRD with AHEI and its components. Associations were also tested between recall SRD in youth and current AHEI.Results: Most participants (35.2%) self-rated diet as “good,” 13.8% as “excellent,” and 4.1% as “poor,” with the remainder split between middle scale points. SRD was not significantly associated with AHEI, although participants with “excellent” vs. “poor” SRD had marginally higher AHEI (P = 0.07). SRD was significantly associated with higher fruit intake (P = 0.02) and marginally associated with intakes of vegetables (P = 0.07) and long-chain fatty acids (P = 0.07). Unexpectedly, AHEI was significantly higher among those reporting “poor” SRD in young adulthood (P = 0.01) or childhood (P = 0.05).Conclusions: SRD may capture current diet quality at extreme intakes. Larger studies should confirm these findings and replicate them in other underrepresented populations. Further research should clarify the inverse associations between adult AHEI and earlier reported SRD.

Background Few studies have assessed multidimensional models for predicting successful aging that incorporate both physical and cognitive-psychosocial elements among minority populations. This study aimed to establish a comprehensive lifestyle behavioral factors score (cLBF) and an integrative successful aging (ISA) score and explore their associations among older Puerto Rican adults. Methods Data were assessed from 889 adults (45-75y) participating in the longitudinal (baseline and 2y follow-up) Boston Puerto Rican Health Study. Higher cLBF score (range 0-10) indicates healthier behaviors (non-smoking, lack of sedentarism, physical activity, high diet quality, and adequate sleep). The physical domain score of ISA included eight components (functional impairment, hypertension, diabetes, cancer, cardiovascular disease, respiratory disease, arthritis, osteoporosis) and ranged 0-11. The cognitive-psychosocial domain of ISA included five components (cognitive impairment, depressive symptoms, social support, perceived stress, and self-rated health) and ranged 0-10. The sum of both domains comprised the ISA score, ranging 0-21. Higher scores of ISA and its domains indicate more successful aging. Results At 2y, the mean ± SD of cLBF score was 4.9 ± 1.8, and ISA was 10.1 ± 3.3. In multivariable-adjusted models, cLBF score was significantly and positively associated with 2-year change in overall ISA (β (95% CI): 0.15 (0.07, 0.24) points), in physical domain (0.09 (0.04, 0.13) points), and in cognitive-psychosocial domain (0.08 (0.02, 0.14) points). Conclusions Maintaining healthier lifestyle behaviors may contribute to successful aging through both physical and cognitive-psychosocial domains. The results support using a multidimensional definition of successful aging in Puerto Ricans and evaluating it in other populations.

No abstract

Traditional diet indices may capture diet quality according to local food culture. Higher adherence to traditional diet scores may help prevent disease, yet evidence in adolescents is limited. This cross-sectional study aimed to develop and validate a Traditional Costa Rica Adolescents Diet Score (TCRAD) and determine its association with sociodemographic characteristics, under the hypothesis that girls, adolescents from rural areas, and with low socioeconomic status, have a more traditional healthy diet. A total of 804 urban and rural adolescents (13–18 years old) participated in the study. The TCRAD showed adequate internal validity as shown by significant associations with intake of 14 traditional foods and nutrients (legumes, vegetables, fruits, oils, dairy, and corn tortilla scored as healthy; and white rice, red/processed meat, solid fats, desserts/pastries, sugar-sweetened beverages, snacks, fast food, and bread and cookies scored as unhealthy). A high TCRAD score, indicative of a healthier and more traditional diet, was observed among adolescents in the low socioeconomic group vs. medium or high socioeconomic categories (42.9, 41.2, and 38.2%, respectively, p < 0.05), adolescents living in rural areas vs. urban (47.6 vs. 34.2%, p < 0.05), and among boys vs. girls (46.9 vs. 37.5%, p < 0.05). The TCRAD score is a valid tool to capture diet quality of adolescents in Costa Rica and could be used to measure association of diet with disease outcomes in this and similar populations. Public health nutrition programs in Costa Rica should focus on improving intake of foods and nutrients, and prioritize girls, adolescents in urban areas, and adolescents with high socioeconomic status.

Introduction:This phase I open-label study examined pharmacokinetics, safety, and tolerability of escalating doses of a novel combination cannabinoid medication (1:1 tetrahydrocannabinol [THC]/cannabidiol [CBD]) in patients with chronic non-cancer pain (CNCP) on high dose opioid analgesia. Methods: Nine people with CNCP and oral morphine equivalent daily dose of 60 mg or higher were recruited. Blood concentrations of THC, 11-hydroxytetrahydrocannabinol (OH-THC), 11-nor-9-carboxy-tetrahydrocannabinol (COOH-THC), and CBD were assayed weekly. Concentrations were measured after a single dose of 2.5 mg THC/2.5 mg CBD on day 1, and daily escalating doses up to a single dose of 12.5 mg THC/12.5 mg CBD on day 29. Followup was on day 36 after a 7-day washout. Secondary outcome data encompassed pain, mood, and sleep parameters. Results: The parent compounds THC, and CBD, and metabolites OH-THC and COOH-THC were detected at most time points. In general, the concentration of all analytes increased until 2 h post-administration,