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Abstract Background Alzheimer’s disease (AD) stands as the leading cause of dementia worldwide, and projections estimate over 150 million patients by 2050. AD prevalence is notably higher in women, nearly twice that of men, with discernible sex differences in certain risk factors. To enhance our understanding of how sex influences the characteristics of AD patients and its potential impact on the disease trajectory, we conducted a comprehensive analysis of demographic, clinical, cognitive, and genetic data from a sizable and well-characterized cohort of AD dementia patients at a memory clinic in Barcelona, Spain. Methods The study cohort comprised individuals with probable and possible AD dementia with a Clinical Dementia Rating (CDR) score between 1 and 3 diagnosed at the Memory Unit from Ace Alzheimer Center Barcelona, Spain, between 2008 and 2018. We obtained cognitive baseline data and follow up scores for the Mini-Mental State Examination (MMSE), the CDR scale, and the neuropsychological battery used in our center (NBACE). We employed various statistical techniques to assess the impact of sex on cognitive evolution in these dementia patients, accounting for other sex-related risk factors identified through Machine Learning methods. Results The study cohort comprised a total of 6108 individuals diagnosed with AD dementia during the study period (28.4% males and 71.6% females). MMSE scores exhibited an average decline of approximately two units per year, unaffected by sex. Similarly, the decline in most neuropsychological functions assessed by NBACE did not exhibit significant differences between males and females. However, we observed that women diagnosed with mild AD dementia progressed more rapidly based on their CDR score (HR = 2.57, 95%CI:2.33–2.84) than men (HR = 2.03, 95%CI: 1.71–2.41) (p-interaction = 0.01). Conclusions Our findings do not strongly support the notion that sex significantly modifies the clinical progression of AD dementia based on cognitive data. Further research is essential to validate whether women with mild AD dementia indeed progress more rapidly than men at a similar stage and to delve into the potential underlying reasons for this finding.

Garantizar la accesibilidad cognitiva en las escuelas supone un gran beneficio para toda la comunidad educativa en general, y además constituye una pieza clave para la inclusión educativa del alumnado con dificultades sensoriales y en las funciones ejecutivas. Dada su relevancia, en este artículo se presenta una propuesta formativa en la que se trabajó la accesibilidad cognitiva con futuros especialistas de pedagogía terapéutica a través de una experiencia de aprendizaje-servicio. En concreto, 39 futuros docentes evaluaron la accesibilidad cognitiva en entornos escolares. Para ello, el alumnado contactó con escuelas de educación infantil y primaria y realizó una auditoría sobre su accesibilidad cognitiva, tras lo cual diseñó un conjunto de propuestas de mejora que fueron transmitidas a los centros. La valoración del estudiantado de esta propuesta formativa se recogió mediante un cuestionario diseñado ad hoc para este estudio compuesto de un total de nueve preguntas tipo Likert y dos preguntas abiertas. Los resultados sugieren que la experiencia fue valorada positivamente por los participantes, quienes reportaron haber incrementado considerablemente sus conocimientos sobre accesibilidad cognitiva y haber mantenido un grado de motivación elevado durante toda la experiencia. Además, desde la perspectiva del alumnado, las escuelas también resultaron beneficiadas por la experiencia y cooperaron activamente con ellos. Los participantes también señalaron algunas dificultades de la experiencia, relacionadas directamente con la metodología de aprendizaje-servicio y con la accesibilidad cognitiva en sí misma.

This paper aims to understand how teachers' attitudes are contributing to or hindering the educational inclusion of students with autism spectrum disorder (ASD). Implicit and explicit measurement of the attitudes of fifty pre-service teachers towards ASD before and after a short-term training on Autism is presented. The explicit measure used was a Likert-type questionnaire, while the implicit measure was a Single Target Implicit Association Test (ST-IAT). After statistical analysis of the data, it was found that prospective teachers' explicit attitudes were positive before the short-term training, and they were significantly better after it. Conversely, participants' implicit attitudes were neutral before the short-term training, and no significant difference was found after it. Additionally, no statistically significant relation was obtained between explicit and implicit attitudes, either before or after training, which suggests that the used instruments measure different attitudinal constructs. According to the remaining findings, it is concluded that explicit attitudes may be more prone to social desirability bias than implicit ones, implying that future attitudes research regarding sensitive topics such as the educational inclusion of students with Autism should combine both measures. Moreover, implicit attitudes seem more difficult to change than explicit ones. Some implications for pre-service teacher education are discussed.

In this study, we used Gross's (2015) emotional regulation model to examine teachers' emotional regulation strategies and the relationship between this emotional regulation and the participation of students with ASD. The sample was selected using a non-probabilistic technique (convenience) with a total of 131 Cuban teachers from primary schools and preschools participating. The results revealed significant differences in the emotional regulation strategies used by teachers which were associated with teaching stage and specific ASD training, with primary school teachers and those who had ASD training obtaining better results. In addition, a significant relationship was found between teachers using cognitive reappraisal of emotions and the participation of students with ASD in school. Practical implications, teacher training programs and lines of future research are discussed.

A total of 40% of children with ASD have clinical symptoms of anxiety. However, there is little research on how teachers respond to this type of behaviour in the classroom. This study aimed to compare teachers' responses towards the anxiety of students with ASD and to explore the relationship between these responses and their ASD awareness and emotional regulation strategies. A quantitative study was conducted using a non-probabilistic sample of 139 Cuban teachers from primary schools and preschools. The results indicate that teachers responses towards the anxiety of students with ASD vary in relation to age, experience in inclusive schools, specific training on educating students with ASD and teaching stage, as well as the type of anxiety. The findings also revealed that emotional regulation and knowledge about ASD had a significant impact on teachers' responses. Practical implications and future lines of research are discussed.

Although the estimated prevalence of ADHD in the school population is 5%, various studies carried out in Latin America have obtained higher figures. This descriptive-cross-sectional research analysed the prevalence of ADHD symptomatology in a random and probabilistic sample of 1535 schoolchildren from Cuenca-Ecuador (aged from 72 to 164 months, 51.3% were female and 50% attended public schools). IQ was evaluated using the Raven's Progressive Matrices Test. The ADHD symptomatology was evaluated using the short version of Conners-3. Descriptive statistics, chi-squares and prevalence data were calculated. We found a total prevalence of ADHD symptomatology of 20.3%. A higher prevalence of ADHD symptomatology was reported among girls compared to boys; and in public schools (compared to private schools). These findings may reflect a higher occurrence of ADHD in vulnerable populations that tend to be less well cared for. Although the results do not come from complete individual clinical evaluations, the representativeness of the sample and the simultaneous presence of scores above the cut-off points in the home and school contexts show a worrying situation that should be taken into account by agents responsible for the design of public health and education policies.

Teachers' knowledge of autism spectrum disorder (ASD) plays a key role in the successful inclusion of children with ASD in regular schools. The objective of this study was to analyze Cuban teachers' knowledge of ASD of at inclusive primary schools and preschools and to compare it with the results obtained in previous studies carried out at an international level. To do this, a cross-sectional study was conducted with Cuban teachers from urban and rural areas throughout the country. The sample was selected using a non-probabilistic technique. In total, 131 primary school and preschool teachers participated. Data were collected by applying the Autism Knowledge Questionnaire (AKQ) that measures ASD knowledge. The results indicated that Cuban teachers had an acceptable knowledge regarding ASD (0.57). Primary education teachers (17.58 ± 4.06) showed a higher level of knowledge than preschool teachers (15.35 ± 2.74). Regarding previous training, teachers who claimed to have received some type of specific ASD training (10.88 ± 3.29) made a greater number of errors than teachers who had not received specific training on ASD (8.91 ± 3.06). At the international level, Cuban teachers were observed to have similar knowledge about ASD when compared to active teachers or pre-service teachers from other countries where similar studies have been carried out. The results suggest that the training of Cuban teachers is not yet optimal to educate students with ASD in primary schools and preschools which are open to diversity.

(1) Teachers' attitudes toward the inclusion of students with autism spectrum disorder (ASD) in mainstream schools influence daily educational practices. Depending on whether these attitudes are favorable or not, inclusive education could be fully or partially reached. This systematic review aims to analyze teachers' attitudes toward ASD and to determine the variables that moderate them. (2) We conducted a systematic review in WoS, Scopus, and PsycINFO databases, obtaining an amount of 16 studies included in this review. (3) The results revealed inconclusive levels in teachers' attitudes: Some of the teachers reported positive attitudes, some neutral, and some negative. (4) Among the variables that probably moderate attitudes, we found knowledge, experience, training, and gender. Future research and implications for pre-service and in-service teachers, school administrators, and policy makers are suggested.

Introduction: Metabolic syndrome (MetS) and hypertriglyceridemic waist (HTW) are two multifactorial pathological conditions that have been increasing in prevalence worldwide. The objective of this study was to evaluate how various sociodemographic variables and healthy habits are associated with the presence or absence of MetS and HTW. Methodology: This study employed a mixed-methods approach, consisting of a retrospective longitudinal study and a cross-sectional descriptive study, analyzing 44,939 healthcare workers with MS and HTW across four professional categories to evaluate the relationship between age, sex, smoking, physical activity, and adherence to the Mediterranean diet using three diagnostic criteria. Descriptive analysis included categorical and quantitative variables, which were assessed through frequencies, Student’s t-test, chi-square, and binary logistic regression models. Logistic regression and Cohen’s kappa were used to evaluate associations and concordances. Age, sex, and lack of physical activity showed the strongest associations with MetS (OR: 2.65–2.84). The results highlight the importance of physical activity and other factors in metabolic prevention. Results: Age, sex, and physical activity were the variables most strongly associated with MetS and HTW across the three evaluated diagnostic criteria. The odds ratios revealed significant values: age (9.07–13.71 for MetS and 13.42 for HTW), sex (2.82–3.31 for MetS and 3.72 for HTW), and physical activity (2.65–2.84 for MetS and 2.40 for HTW). Conclusions: The risk of developing MetS and HTW among healthcare personnel is influenced by lifestyle habits, sex, and age, with the highest ORs observed in nursing assistants and orderlies. Future research that delves deeper into the causal relationship between lifestyle factors and the severity of MetS and HTW in healthcare personnel will improve understanding and facilitate the development of preventive activities to reduce their incidence.

Summary: Background: The identification of patients with an elevated risk of developing Alzheimer's disease (AD) dementia and eligible for the disease-modifying treatments (DMTs) in the earliest stages is one of the greatest challenges in the clinical practice. Plasma biomarkers has the potential to predict these issues, but further research is still needed to translate them to clinical practice. Here we evaluated the clinical applicability of plasma pTau181 as a predictive marker of AD pathology in a large real-world cohort of a memory clinic. Methods: Three independent cohorts (modelling [n = 991, 59.7% female], testing [n = 642, 56.2% female] and validation [n = 441, 55.1% female]) of real-world patients with subjective cognitive decline (SCD), mild cognitive impairment (MCI), AD dementia, and other dementias were included. Paired cerebrospinal fluid (CSF) and plasma samples were used to measure AT(N) CSF biomarkers and plasma pTau181. Findings: CSF and plasma pTau181 showed correlation in all phenotypes except in SCD and other dementias. Age significantly influenced the biomarker's performance. The general Aβ(+) vs Aβ(−) ROC curve showed an AUC = 0.77 [0.74–0.80], whereas the specific ROC curve of MCI due to AD vs non-AD MCI showed an AUC = 0.89 [0.85–0.93]. A cut-off value of 1.30 pg/ml of plasma pTau181 exhibited a sensitivity of 93.57% [88.72–96.52], specificity of 72.38% [62.51–79.01], VPP of 77.85% [70.61–83.54], and 8.30% false negatives in the subjects with MCI of the testing cohort. The HR of cox regression showed that patients with MCI up to this cut-off value exhibited a HR = 1.84 [1.05–3.22] higher risk to convert to AD dementia than patients with MCI below the cut-off value. Interpretation: Plasma pTau181 has the potential to be used in the memory clinics as a screening biomarker of AD pathology in subjects with MCI, presenting a valuable prognostic utility in predicting the MCI conversion to AD dementia. In the context of a real-world population, a confirmatory test employing gold-standard procedures is still advisable. Funding: This study has been mainly funded by Ace Alzheimer Center Barcelona, Instituto de Salud Carlos III (ISCIII), Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Spanish Ministry of Science and Innovation, Fundación ADEY, Fundación Echevarne and Grífols S.A.

Summary: The increasing frequency and severity of droughts present a significant risk to vulnerable regions of the globe, potentially leading to substantial human displacement in extreme situations. Drought-induced displacement is a complex and multifaceted issue that can perpetuate cycles of poverty, exacerbate food and water scarcity, and reinforce socio-economic inequalities. However, our understanding of human mobility in drought scenarios is currently limited, inhibiting accurate predictions and effective policy responses. Drought-induced displacement is driven by numerous factors and identifying its key drivers, causal-effect lags, and consequential effects is often challenging, typically relying on mechanistic models and qualitative assumptions. This paper presents a novel, data-driven methodology, grounded in causal discovery, to retrieve the drivers of drought-induced displacement within Somalia from 2016 to 2023. Our model exposes the intertwined vulnerabilities and the leading times that connect drought impacts, water and food security systems along with episodes of violent conflict, emphasizing that causal mechanisms change across districts. These findings pave the way for the development of algorithms with the ability to learn from human mobility data, enhancing anticipatory action, policy formulation, and humanitarian aid.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common cause of chronic liver disease worldwide, with a multifactorial etiology. This study aims to evaluate the associations between various sociodemographic variables, healthy habits, and stress with risk scale values for MAFLD. Materials and Methods: A descriptive, cross-sectional study was conducted on 16,708 Spanish workers to assess how sociodemographic variables (age, gender, and socioeconomic status), healthy habits (smoking, Mediterranean diet adherence, and physical activity), and stress correlate with values from three MAFLD risk scales: fatty liver index (FLI), hepatic steatosis index (HSI), and lipid accumulation product (LAP). Results: All analyzed variables were associated with the values of the three MAFLD risk scales. Among them, the variables showing the strongest associations (represented by odds ratio values) were age and physical activity. Conclusions: The profile of an individual at higher risk of elevated MAFLD risk scale values is a male, aged 50 or older, belonging to lower socioeconomic levels (manual laborers), a smoker, sedentary, with low adherence to the Mediterranean diet, and with high stress scale scores.

Background and Objectives: The accumulation of fat in the body, especially visceral fat, is associated with various cardiometabolic conditions such as diabetes mellitus and fatty liver. The reasons for the accumulation of this fat are diverse. Some studies, also in the working population, have shown a clear association between sociodemographic variables and health habits with scales that assess overweight and obesity. This study aims to determine how certain sociodemographic variables, such as age, gender, and socioeconomic level, as well as certain healthy habits like physical activity and tobacco consumption, affect the levels of body and visceral fat. Materials and Methods: We conducted a descriptive and cross-sectional study involving 8590 Spanish workers. The percentage of body and visceral fat was measured using a bioimpedance analysis with a Tanita DC 430MA device. Results: Both the average values and the prevalence of elevated body and visceral fat increase with age and decrease with social class and lower levels of physical activity. These values are higher in smokers. A multivariate analysis shows that the variables most influential in increasing the risk of high levels of both body and visceral fat are age and low levels of physical activity. Conclusions: The profile of a person at high risk of having elevated body and visceral fat levels is an older male with a low socioeconomic status who smokes and leads a sedentary lifestyle.

Background: Shift work has been associated with unhealthy lifestyle habits and a higher prevalence of obesity, which negatively impacts the health of shift workers. The objective of our study was to examine the influence of shift work on obesity, as well as on sociodemographic variables, anthropometric measurements, and lifestyle habits in individuals working this type of schedule. Methods: An observational, cross-sectional, descriptive study involving 53,053 workers from various labour sectors across several Spanish autonomous communities was conducted. It included 31,753 men (17,527 of them working shifts) and 21,300 women (11,281 of them working shifts). The relationship between shift work and obesity was examined, as well as its association with sex, age, social class, education level, smoking, alcohol consumption, sedentary behaviour, and unhealthy diet. Results: Obesity showed higher prevalence and mean values among shift workers across all four formulas used (BMI obesity, WtHR high, CUN BAE obesity, METS-VF high). All variables related to unhealthy lifestyle habits revealed a significantly greater prevalence among shift workers, with high statistical significance (p < 0.001). Age, sex, and social class affected the risk of obesity, with a greater prevalence observed in shift workers compared to non-shift workers (p < 0.001). Men had a higher risk than women, with an OR ranging from 1.17 (1.12–1.21) for BMI obesity to 7.45 (6.71–8.20) for METS-VF high. Conclusions: Shift workers exhibit a higher prevalence of obesity and unhealthy lifestyle habits, with men at greater risk. The variables that most significantly increase the risk of obesity include age, physical inactivity, low adherence to the Mediterranean diet, and alcohol consumption.

Inclusive education is currently one of the main aspirations of the Spanish educational system and one of the key aspects for its achievement is teachers' attitudes toward educational inclusion. In recent years, many studies worldwide have analyzed this aspect, but so far, any systematic review has specifically focused on the Spanish educational framework. For this reason, the purpose of this paper is to review the studies published from 2010 to 2019 whose aim was to analyze teachers' attitudes towards educational inclusion in Spain. After a literature search in four different databases (PsycInfo, ERIC, Dialnet Plus, and Google Scholar), 34 studies were selected and reviewed. The results suggest that Spanish teachers' attitudes toward educational inclusion are generally positive, although in some cases they are ambiguous. Teachers' attitudes are mainly influenced by the amount of training and their contact or not with students with special educational needs. The discussion highlights that more studies with a greater methodological diversity are required in order to provide a complete analysis of teachers' attitudes toward inclusion and that teacher training is one of the best tools to generate positive attitudes.

The teaching guides that complement textbooks have key importance in the assessment of competence in problem solving, because these materials contain the assessment tools that teachers frequently use to quantify the achievements of their students. In this paper, we set two aims: to analyze which curriculum contents are given priority in the assessment tests of the teaching guides; and to check to what extent these tests assess the steps of the mathematical problem solving process. For this, an analysis of the initial and final assessment tests of six Spanish publishers was conducted. The results show that the distribution of mathematical tasks by type of content does not fully conform to the theoretical framework proposed by TIMSS. In addition, only one of the six publishers considered the problem-solving process as evaluable.

Changes in the classification of autism and Asperger's syndrome led to changes in social perception of ASD. Since last criteria, studies indicate higher levels of stigma towards ASD than towards Asperger's. These prejudices are barriers to inclusive education. Thus, it is relevant (1) to evaluate pre-service teachers' self-efficacy towards the label of ASD; (2) to evaluate pre-service teachers' self-efficacy towards the label of Asperger's; and (3) to compare those results to analyse whether the use of different diagnostic labels brings about different levels of self-efficacy. One hundred and eighty-six primary education pre-service teachers participated in the current study. Two adaptations of the Autism Self-Efficacy Scale for Teachers (ASSET) were used: a version with the label of 'ASD' (n = 96) and another for 'Asperger's' (n = 90). The scores obtained by the group asked about ASD were high according to the ASSET score range, while the scores obtained by the group asked about Asperger's were medium. After comparing the results, participants asked about the label ASD showed higher levels of self-efficacy than participants asked about Asperger's. These results could be a consequence of the consolidation of the ASD diagnosis among society and the higher presence of children with ASD in schools and cultural products, among other factors.

The Iron Age site of Tossal de Baltarga (Bellver de Cerdanya) was a large Iberian residential complex occupying a strategic position in the middle of the Eastern Pyrenees. It was destroyed by fire in the second half of the 3rd century BCE, preserving an important volume of archaeological and bioarchaeological material in certain areas. This is the case of Building G, a two-story construction whose violent blaze has offered the possibility of analyzing a precise moment in the history of an Iron Age productive unit. The existence of a stable on the lower floor, where four sheep, a goat, and a horse were documented, and an upper floor, where textile production and storage were evidenced, allows us to analyse the complexity of the economic activities and exploitation of local resources, such as livestock, agriculture, forestry and mining.

Abstract Climate change is leading to more extreme weather hazards, forcing human populations to be displaced. We employ explainable machine learning techniques to model and understand internal displacement flows and patterns from observational data alone. For this purpose, a large, harmonized, global database of disaster-induced movements in the presence of floods, storms, and landslides during 2016–2021 is presented. We account for environmental, societal, and economic factors to predict the number of displaced persons per event in the affected regions. Here we show that displacements can be primarily attributed to the combination of poor household conditions and intense precipitation, as revealed through the interpretation of the trained models using both Shapley values and causality-based methods. We hence provide empirical evidence that differential or uneven vulnerability exists and provide a means for its quantification, which could help advance evidence-based mitigation and adaptation planning efforts.

Background: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, accounting for one-third of all global deaths. The World Health Organization (WHO) asserts that prevention is the most effective strategy to combat CVD, emphasizing the need for non-invasive, low-cost tools to identify individuals at high risk of CVD. Atherogenic indices and heart age (HA) are valuable tools for assessing cardiovascular risk (CVR). The aim of our study was to evaluate the association between atherogenic indices and HA. Methods: A cross-sectional study was conducted involving 139,634 Spanish workers to determine the association between three atherogenic indices and HA. ROC curves were employed to identify the cut-off values for the various atherogenic indices used to estimate high HA. The cut-off points, along with their sensitivity, specificity, and Youden index, were determined, and the area under the curve (AUC) was calculated. Results: As the values of the atherogenic indices increased, so did the risk of having elevated avoidable lost life years (ALLY) HA. In the ROC curve analysis, the AUC with the best results corresponded to the total cholesterol/HDL-c atherogenic index, with an AUC of 0.803 in females and 0.790 in males. The LDL-c/HDL-c atherogenic index showed an AUC of 0.780 in women and 0.750 in men, with Youden indices around 0.4. When analyzing the AUC of the atherogenic index for triglycerides/HDL-c, the results were 0.760 in women and 0.746 in men. Conclusions: Atherogenic indices and HA show a close relationship, with an increase in these indices leading to a rise in HA values. Raising patient awareness that as their CVR levels increase, so does their HA may be useful in achieving some benefit in reducing CVR.

PurposeThe aim of the present study was to examine the relationship between perceived physical literacy and obesity-related outcomes among adolescents from Spain.MethodsThis is a secondary cross-sectional analysis including a total sample of 845 Spanish adolescents (55.3% girls) aged 12–17 years from the Valle de Ricote (Region of Murcia) from the Eating Healthy and Daily Life Activities (EHDLA) project. Physical literacy was evaluated using the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). Body mass index was computed by taking the participants’ body weight in kilograms and dividing it by the square of their height in meters, and body mass index (z score) and overweight/obesity and obesity were computed by the World Health Organization age- and sex-specific thresholds. Waist circumference was measured using a constant tension tape. Moreover, the waist-to-height ratio was calculated, and therefore, abdominal obesity was determined. Skinfold measurements were taken at the triceps and medial calf using calibrated steel calipers.ResultsIn general, the overall trend was downward (i.e., the higher the PPLI score the lower the obesity-related indicators), with the approximate significance of smooth terms being statistically significant for all models examined (p