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BackgroundAtrial fibrillation (AF) is an important heart rhythm disorder in aging populations. The gut microbiome composition has been previously related to cardiovascular disease risk factors. Whether the gut microbial profile is also associated with the risk of AF remains unknown.MethodsWe examined the associations of prevalent and incident AF with gut microbiota in the FINRISK 2002 study, a random population sample of 6763 individuals. We replicated our findings in an independent case-control cohort of 138 individuals in Hamburg, Germany.FindingsMultivariable-adjusted regression models revealed that prevalent AF (N = 116) was associated with nine microbial genera. Incident AF (N = 539) over a median follow-up of 15 years was associated with eight microbial genera with false discovery rate (FDR)-corrected P

Este artículo relata una experiencia de mentoría social en educación artística desarrollada en el contexto del programa Fénix Andalucía de la Estrategia Regional Andaluza para la Cohesión e Inclusión Social (ERACIS) para desarrollar competencias en el alumnado de las zonas ERACIS y su inclusión social y educativa realizando acciones colectivas centradas en el desarrollo de la creatividad y el uso de herramientas digitales e interactivas, aplicadas a través de la unidad didáctica integrada del ámbito artístico del programa. Para la medición de la investigación se han utilizado metodologías activas propias del programa, así como metodologías artísticas. Los resultados permiten comprobar la eficacia de la mentoría social para la inclusión socioeducativa, y la oportunidad de instaurar dichas metodologías en el contexto educativo. La experiencia ha permitido al alumnado el desarrollo de habilidades artísticas, digitales y de emprendimiento, así como la mejora de sus competencias en conciencia y expresiones culturales.

Introduction and Objectives: Although amoxicillin-clavulanate combination (ACC) is a well-established cause of liver injury, clinicians are unaware of some aspects that explain why its diagnosis may be initially missed, making the patient susceptible to unnecessary exploration or treatment. This study aimed to describe DILI characteristics linked to ACC in the LATINDILI registry. Materials and Methods: We revised data concerning DILI-ACC in the LATINDILI registry during the last decade, looking for information on latency, pattern, severity, and evolution. Baseline characteristics were described using mean, median, and percentages; Student's t-test or a chi-squared test was used to determine the difference between mean and frequencies. A P-value of less than 0.05 was considered statistical significance. Results: We identified 61 DILI-ACC episodes in 60 patients from the LATINDILI registry. The mean age was 58 years (19-90 y), and 54% were male. Median latency was 21 days, with median ALT and ALP at DILI onset of 282 U/L (range 34-2130) and 585 U/L (range 96-1626), respectively; a cholestatic/mixed pattern predominated in 43 cases. In 53 cases, the liver injury appeared with a mean of 13 days (range 2-39 d) after treatment ended. Twenty patients (33%) had allergic immune features, 79% were jaundiced, and 61% required hospitalization. The mean total bilirubin values increased by 7.5 mg/dl (1.5-16) from the onset in 24 of 42 evaluable patients after ten days (range 2-30). Table 1 shows the comparison between groups. Resolution of liver injury occurred on average 64 (14-270) days, one patient did not normalize after 365 days, and no death was consigned. Conclusions: Jaundice linked to a cholestatic/mixed pattern appearing after stopping therapy was a frequent presentation of ACC in our analysis. This clinical presentation may be missed when using ACC and explaining the delayed diagnosis. Worsening bilirubin value is frequent and may be related to longer treatment duration and prolonged latency.

Introduction and Objectives: Idiosyncratic drug-induced liver injury (DILI) caused by antineoplastic and biological agents is an emerging clinical burden in oncologic patients. However, clinical characteristics of DILI due to these drugs remain poorly understood. This study aimed to assess the clinical presentation and outcome of DILI caused by antineoplastic and biological agents in patients enrolled in the prospective Spanish and Latin American DILI registries. Materials and Methods: Information from well-vetted DILI cases caused by antineoplastic and biological agents enrolled in the Spanish DILI Registry (n=38) and the LATINDILI Network (n=33) since their establishment in 2022 was retrieved. Demographics, clinical characteristics, laboratory findings and outcome were analyzed through descriptive statistics. Results: Overall, DILI patients were aged 61±17 years, with Latin American patients slightly younger than Spanish cases (64 vs. 56; p=0.053) and were predominantly men (66%). Novel therapies such as Protein Kinase Inhibitors represented 14% of cases, while Immune Checkpoint Inhibitors caused 6% of DILI cases. Hepatocellular damage predominated (79%), while 12% had a cholestatic injury. Nearly 70% of patients developed jaundice, and 49% were hospitalized. Alanine and aspartate aminotransferase were highly increased (median values 13 and 11 times above the upper limit of normal (ULN), respectively), while alkaline phosphatase showed modest elevations (1.3 times ULN). Total bilirubin was elevated by a median of 3.7-fold ULN. Most of the patients coursed with a moderate injury (46%), and 15% developed severe liver damage. Four Spanish cases, and one from Latin America, had liver-related death (p=0.018). There were no chronic DILI cases, and 71% of patients resolved spontaneously. Conclusions: DILI, due to antineoplastic and biological agents, was more common in men, caused a hepatocellular injury, and usually coursed as a moderate-to-severe liver injury. Latin American cases were slightly younger, while the mortality rate was higher among Spanish DILI patients.

Este artículo tiene como objeto revisar la importancia del desarrollo de acciones de innovación social y creatividad en el ámbito del ocio para las personas con discapacidad intelectual en particular, y para la sociedad en general, a través de un estudio de caso: el proyecto PDICIENCIA. Este aborda de forma proactiva la plena inclusión de las personas con discapacidad intelectual a través de acciones innovadoras que fomentan la cultura científica, tecnológica y de la innovación entre públicos habitualmente alejados de estas áreas. Además, empodera a las personas con discapacidad intelectual para dotarlas de unas habilidades profesionales y sociales. Veremos cómo su participación activa en actividades de creatividad, divulgación científica o producción cinematográfica, implantadas a través de los planes de atención individualizados de la Asociación de Familiares y Amigos de Personas con Discapacidad Intelectual (AFAMP) en la Residencia Pedro Gámez de Bailén (Jaén), puede incidir en la mejora de su calidad de vida.

The Sustainable Development Goals (SDGs) represent a commitment to sustainability through innovation, sustainable economic growth and the diversification of economic activities. The social economy and the revaluation of rural heritage play a fundamental role in implementing and progressing towards these goals, especially in agri-food cooperatives. In the case of the Spanish olive oil industry, a substantial percentage of the business in olive oil producing areas revolves around the social economy: 70% of the olive oil produced in Spain is made by cooperatives. For these cooperatives, the implementation of the SDGs offers them a potential tool for sustainable development, diversification and the economic growth of their businesses. This article focuses on analysing the relative importance of the SDGs in the olive oil cooperative sector in Andalusia, using the Qualitative Comparative Analysis (QCA) technique and applying the fuzzy-set approach (fsQCA) to the tenets of the SDGs. Lastly, causal models have been established, the practical implications of which centre on the implementation and development of the SDGs as a means of achieving the sustainable economic growth of these enterprises. The main findings of this study suggest that the sustainable development goals on which the cooperative societies analyzed are focused, in addition to producing olive oil, promote values linked to food security, sustainability, the showcasing of heritage, and gender equality.

Transcranial electrical stimulation (tES) has shown promise in the treatment of conditions such as depression and chronic pain with mild-to-moderate adverse effects (AEs). Few previous studies have attempted to identify factors predicting tES-induced AEs. In particular, AEs resulting from repeated sessions of tES remain understudied. We conducted an exploratory retrospective analysis of two independent randomized controlled studies to investigate whether lifestyle factors (i.e. chronic alcohol use, smoking, exercise, and quality and length of sleep) modify the severity and frequency of tES-induced AEs, and evaluated the progression of AEs over repeated sessions. We utilized two double-blinded samples: 1) a male sample (n=82) randomized to receive transcranial direct current stimulation (tDCS) or sham for 5 days, and 2) a mixed-sex sample (n=60) who received both transcranial random noise stimulation (tRNS) and sham in a crossover setting. The severity of AEs was recorded on a scale of 0-100. The data was analysed using negative binomial models. In addition, we performed power calculations and, to guide future research, evaluated the numbers of individuals needed to detect non-significant observations as significant. By day 5, the tDCS group experienced more sensations under the electrodes than the sham group. Alcohol use, smoking, exercise, or quality or duration of sleep did not appear to be associated with the intensity of the AEs. The subsequent power analyses indicated that substantially larger samples would be needed to detect the observed associations as significant. Repetitive sessions do not appear to introduce additional AE burden to individuals receiving either tDCS or tRNS, at least with protocols lasting up to 5 days. Alcohol use, smoking, exercise, or quality or duration of sleep appear to only have an effect of negligible size, if any, on AEs induced by tDCS or tRNS, and studies with sample sizes ranging from roughly 100 individuals to hundreds of thousands of individuals would be required to detect such effects as significant.

Opposed to the historical concept of the olive oil mills as places just for transporting the fruit, milling and olive oil production, the growing interest in its museumization is turning them into gastronomic, cultural and ethnographic points of reference. This study analysed the components of the museumization of Andalusian olive oil mills, using the Qualitative Comparative Analysis (QCA) technique and employing the fuzzy-set approach (fsQCA). To that end, it draws on the definition of museum put forward by the more progressive elements of the International Council of Museums (ICOM). The main implication from the results is that olive oil mill professionals should adapt the museum offer according to the needs and aspects identified by the causality results of the model, and design museumization strategies with actions tailored to olive oil tourism, in order to more effectively tackle the transformations needed in the sector and enable the conservation of olive cultural heritage.

Introduction: Idiosyncratic drug-induced liver injury (DILI) is a complex hepatic condition whose diagnosis is challenging due to lack of specific biomarkers. Objectives: We aimed to evaluate serum metabolomic differences between patients with DILI and with other causes of liver injury in search for specific DILI biomarkers. Methods: Metabolomic profiles of serum samples from 26 Spanish DILI patients, 34 with non-DILI acute liver injury (ALI) and 48 healthy controls, were analyzed using UHPLC-MS. To assess changes in disease progression, DILI and ALI patients were followed-up from detection (visit 1), one week (visit 2) and >30 days (visit 3). Data were analyzed using Shapiro-Wilk, Student's t and Wilcoxon tests. Results: Several amino acids, fatty acids (FAs), LPI and bile acids were increased, whereas the glycerophospholipids MEPE and MAPC were decreased (p0,05). Conclusion: Most metabolomic differences are found at times closer to DILI recognition (visits 1&2), although abnormal values of FAs remain during recovery. Some FAs species and the amino acids taurine, Phe-Phe glutamic acid, lysine, tryptophan and alanine seem promising DILI biomarker candidates that should be further explored. Funding: CIBERehd, ISCiii-FEDER PI18/00901, PI19/00883.

Introduction: Idiosyncratic DILI is a challenging condition, believed to involve the immune system. This hypothesis is supported by various identified HLA risk alleles. Objectives: To evaluate a potential role of the immune system in DILI through leukocyte immunophenotyping. Methods: Blood samples were collected from adjudicated DILI (n=12) and viral hepatitis (VH, 13) at day 1 (recognition), 7 and >30. A single blood sample was extracted from healthy liver controls (HLC, 54). Leukocyte populations and immune checkpoint expressions were determined based on cell surface receptors, except for CTLA-4 that was determined intracellularly, using multiparametric flow cytometry. Results: No differences were detected in leukocytes, lymphocytes or neutrophils counts at day 1. However, DILI (0.57 × 10E09/L, p=0.037) and HV (1.41 × 10E09/L, p

Introduction: In 2011, the Latin-American DILI-Network (LATINDILIN) set up under the guidance of the Spanish DILI Registry a network of hepatologists to prospectively identify and characterize DILI patients. Aim: To evaluate the drugs more frequently associated with DILI in LA, clinical phenotype and outcome. Methods: Demographics, clinical and biochemical parameters of all cases included in the LATINDILI Network were analysed according to the type of liver injury (hepatocellular, Hep; cholestatic, Chol and mixed, Mix). Results: 404 DILI cases were included. Anti-infectives (31%), musculoskeletal system drugs (13%) and herbal products (9.2%) were the main causative therapeutic drug classes. Mean age was 49 years (female sex, 61%). Hep injury predominated (62%) whereas Chol and Mix patterns were 24% and 15% of cases, respectively. Chol patients (mean age 56y) were older than Hep and Mix cases (47 and 50, p

The Social Economy plays a fundamental role in the implementation and development of social innova-tion practices, especially in the field of cooperatives. In the case of agri-food cooperatives in the olive oil producing areas of Spain, a substantial share of the business is based around the social economy, with CIRIEC reporting a cooperativization rate of 70%. As such, there are increasing opportunities for these cooperatives to adopt tools that enable the potential development of social innovation actions. In the present article, we conduct a literature review to explore the definitions of social innovation provided in the last decade. We then analyse the results relating to a proposed model of social innovation applied to the olive oil industry, involving the participation of an expert panel composed of people with a position on the board of directors or managers of olive oil cooperatives and companies in the olive oil industry. From the analysis of the data collected, we identify four dimensions of Social Innovation that are particularly relevant to the olive oil industry: the Economic Dimension, the Cultural Dimension, the Environmental Dimension, and the Technological Dimension. These dimensions give rise to a methodological model for the implementation of Social Innovation actions in the olive oil industry.

En un universo global donde el mundo rural tan solo se concibe como un entorno secundario, destinado preferentemente a la generación de recursos económicos y vacacionales, el arte se convierte en una herramienta válida para generar nuevos estímulos que permitan su recuperación como espacio de vida. Concretamente, el proyecto Murales Conciencia, desarrollado en Bailén (Jaén), plantea la creación de una colección de arte público a través de la utilización del propio municipio como continente, que se completa con un museo virtual. Artistas relevantes en el ámbito de la tipología mural, han conformado una colección única que se fundamenta en dos pilares básicos: el Patrimonio y la Ciencia. En este trabajo abordamos la construcción de un proyecto singular que, además de reconvertir estéticamente enclaves denostados de la localidad, ha favorecido la creación de ámbitos comunitarios y de memoria, repletos de conocimiento y responsabilidad social.

Access to employment is considered to be one of the most important factors for integration in our society, given that since the Industrial Revolution a system of social wellbeing has been built in tum, on employment. However, certain community exist which have serious difficulties in integrating «normalised» into the labour market and specialized organizations have instigated alternative methods of employment for them. These Companies of Insertion operate in market activities, at the same time associating with them a process of integration. This report is an attempt to identify the principle aspects or dimensions involved in the Good Practices of these Insertion Companies, in systemizing their characteristics and appointing keys for their success. The incentive for doing this research is part of the necessity to create standards which facilitate the progress of the good practices in the Companies of Insertion, which at the moment exist in an insufficient conceptual framework, experimental and normative of the subject.

Este trabajo refleja el relato de una experiencia artística desarrollada en Ecuador, concretamente en la zona biogeográfica del Chocó, al norte del país. Esta región, ubicada en la cara occidental de la cordillera de los Andes, alberga uno de los puntos calientes de biodiversidad más importantes del planeta, y también es la región del mundo con mayores registros pluviométricos, atrapando las nubes desde los 800 metros y alcanzando entre 3.000 y 10.000 mm de lluvia al año. El objetivo no era otro que registrar una muestra de la enorme biodiversidad del Chocó a través de apuntes del natural en cuaderno de campo. Para ello, se realizó una estancia en la Reserva Mashpi, que cuenta con laboratorio, centro de investigación, hotel y red de senderos, para la toma de apuntes del natural de las especies de flora y fauna presentes en la reserva, y la realización de una obra de mayor envergadura basada en esos apuntes realizados para su utilización en sensibilización y divulgación medioambiental. Un proyecto que vincula ciencia, arte y experiencia directa a partes iguales y que ha involucrado a toda una comunidad científica, artística e investigadora para su consecución. Trabajo apoyado económicamente por la Escuela de Doctorado de la Universidad de Jaén.

Ortega, E. (2020). “Retos de los stakeholders del ámbito de la discapacidad en materia de empleo tras la crisis del COVID-19”. Revista Española de Discapacidad, 8(I), pp. 209-217.

BackgroundTranscranial direct current stimulation (tDCS), a putative treatment for depression, has been proposed to affect peripheral metabolism. Metabolic products from brain tissue may also cross the blood–brain barrier, reflecting the conditions in the brain. However, there are no previous data regarding the effect of tDCS on circulating metabolites.ObjectiveTo determine whether five daily sessions of tDCS modulate peripheral metabolites in healthy adult men.MethodsThis double-blind, randomized controlled trial involved 79 healthy males (aged 20–40 years) divided into two groups, one receiving tDCS (2 mA) and the other sham stimulated. The anode was placed over the left dorsolateral prefrontal cortex and the cathode over the corresponding contralateral area. Venous blood samples were obtained before and after the first stimulation session, and after the fifth stimulation session. Serum levels of 102 metabolites were determined by mass spectrometry. The results were analysed with generalised estimating equations corrected for the family-wise error rate. In addition, we performed power calculations estimating sample sizes necessary for future research.ResultsTDCS-related variation in serum metabolite levels was extremely small and statistically non-significant. Power calculations indicated that for the observed variation to be deemed significant, samples sizes of up to 11,000 subjects per group would be required, depending on the metabolite of interest.ConclusionOur study found that five sessions of tDCS induced no major effects on peripheral metabolites among healthy men. These observations support the view of tDCS as a safe treatment that does not induce significant changes in the measured peripheral metabolites in healthy male subjects.

Background: Non-alcoholic fatty liver disease (NAFLD) and idiosyncratic drug-induced liver injury (DILI) could share molecular mechanisms involving the immune system. We aimed to identify activation immunological biomarkers in invariant natural killer T (iNKT) and CD4/CD8+ T cells in NAFLD and DILI. Methods: We analyzed the activation profile (CD69, CD25, and HLA-DR) and natural killer group 2 member D (NKG2D) on iNKT cells, and CD4/CD8 T cells in peripheral blood mononuclear cells from NAFLD, with or without significant liver fibrosis, and DILI patients. Results: There was an increase in iNKT cells in NAFLD patients compared to DILI or control subjects. Regarding the cellular activation profile, NAFLD with significant liver fibrosis (F ≥ 2) displayed higher levels of CD69+iNKT cells compared to NAFLD with none or mild liver fibrosis (F ≤ 1) and control patients. CD69+iNKT positively correlated with insulin resistance, aspartate aminotransferase (AST) level, liver fibrosis-4 index (FIB4) and AST to Platelet Ratio Index (APRI). DILI patients showed an increase in CD69+ and HLA-DR+ in both CD4+ and CD8+ T cells, detecting the most relevant difference in the case of CD69+CD8+ T cells. Conclusions: CD69+iNKT may be a biomarker to assess liver fibrosis progression in NAFLD. CD69+CD8+ T cells were identified as a potential distinctive biomarker for distinguishing DILI from NAFLD.

Aims: Dementia is a major health problem. Cardiovascular diseases (CVD) and risk factors are associated with incident dementia. However, whether there is an association among CVD, Alzheimer's disease (AD) and vascular dementia (VD) at the population level remains unclear. Methods: We analysed the association between CVD (heart failure [HF], atrial fibrillation [AF], myocardial infarction [MI], peripheral arterial disease, stroke and transient ischemic attack) and the incidence of dementia using nationwide FinnGen data of 218,192 individuals. The last follow‐up information on dementia was available from October 2021. Results: The age at the end of the follow‐up was 61.7 ± 17.1 years, and 53% were women. Overall, we observed 9701 (4.4%) dementia, 6323 (2.9%) AD and 1918 (0.7%) VD cases. Individuals with CVD had a higher risk of developing dementia than unexposed individuals. In the multivariable‐adjusted Cox models, stroke was most strongly associated with dementia (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.6–1.8). CVD was more strongly associated with VD than with AD. Individuals with HF and MI had an increased risk of AD (HF: HR 1.11, 95% CI 1.04–1.19; MI: HR 1.10, 95% CI 1.02–1.18). AF was associated with VD (HR 1.58, 95% CI 1.42–1.77), but not with AD (HR 1.03, 95% CI 0.97–1.09). Clinical characteristics, such as diabetes, smoking and alcohol abuse, were associated with both types of dementia. Conclusion: All major CVDs were associated with an increased risk of developing dementia, particularly VD. Therefore, CVD onset should prompt an assessment of cognitive decline and possible preventive measures. [ABSTRACT FROM AUTHOR]

Background Since the introduction of direct-acting antivirals, thousands of chronic hepatitis C patients have been successfully treated. However, vulnerable populations have a higher prevalence of hepatitis C virus (HCV) infection and face barriers that impede their access to antivirals. We carried out an HCV microelimination program focused on vulnerable population groups in Malaga. Methods People in drug addiction treatment centers and homeless shelters in Malaga who participated in the program between October 2020 and October 2021 were included. After providing participants with educational information on HCV, a dry drop test (DDT) was used to collect blood for subsequent screening for HCV infection. The participants who were diagnosed with HCV infection were scheduled for comprehensive healthcare assessments, including blood tests, ultrasonography, elastography, and the prescription of antivirals, all conducted in a single hospital visit. Sustained viral response (SVR) was analysed 12 weeks after end of treatment. Results Of the 417 persons invited to participate, 271 (65%) agreed to participate in the program. These participants were screened for HCV infection and 28 of them were diagnosed with HCV infection (10%). These hepatitis C-infected patients had a mean age of 53 ± 9 years; 86% were males and 93% were or had been drug users. Among 23 patients with HCV infection, HCV genotype 1a predominated (74%). Medical exams showed that 19% (4/21) had advanced fibrosis (F3–4), and 5% (1/21) had portal hypertension. Finally, 23 infected patients received treatment with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir and SVR was confirmed in 22 patients (96%). Conclusions Drug users and homeless people have a higher prevalence of HCV infection than the general population. The microelimination program with educational activity and screening tools achieved a high participation rate, easy healthcare access, and a high rate of SVR despite the SARS-CoV-2 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. Objective: The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use. Material and methods: A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. Results: Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. Conclusions: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.