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Background & Aims: The COVID-19 pandemic has had a major negative impact on health systems and many chronic diseases globally. We aimed to evaluate the impact of the first year of the pandemic on the outcomes of people with NAFLD cirrhosis. Methods: We conducted a before-after study in four University hospitals in Catalonia, Spain. Study subperiods were divided into Pre-pandemic (March/2019–February/2020) vs. Pandemic (March/2020–February/2021). The primary outcome was the rate of first liver-related event (LRE). Overall clinical outcomes (LREs plus cardiovascular plus all-cause mortality) were also assessed. Results: A total of 354 patients were included, all of whom were compensated at the beginning of the study period; 83 individuals (23.5%) had a history of prior hepatic decompensation. Mean age was 67.3 years and 48.3% were female. Median BMI was 31.2 kg/m2 and type 2 diabetes was present in 72.8% of patients. The rates of first LRE in the Pre-pandemic and Pandemic periods were 7.4% and 11.3% (p = 0.12), respectively. Whilst the rate of overall events was significantly higher in the Pandemic period (9.9% vs. 17.8%; p = 0.009), this was strongly associated with COVID-19-related deaths. The rate of worsened metabolic status was significantly higher in the Pandemic period (38.4% vs. 46.1%; p = 0.041), yet this was not associated with the risk of first LRE during the Pandemic period, whereas type 2 diabetes (odds ratio [OR] 3.77; 95% CI 1.15–12.32; p = 0.028), albumin 2.67 (OR 15.74; 95% CI 2.01–123.22; p = 0.009) were identified as risk factors in the multivariable analysis. Conclusion: Overall, people with NAFLD cirrhosis did not present poorer liver-related outcomes during the first year of the pandemic. Health system preparedness seems key to ensure that people with NAFLD cirrhosis receive appropriate care during health crises. Lay summary: Mobility restrictions and social stress induced by the COVID-19 pandemic have led to increased alcohol drinking and worsened metabolic control (e.g., weight gain, poor control of diabetes) in a large proportion of the population in many countries. We aimed to analyze whether people with cirrhosis due to non-alcoholic fatty liver disease, who are particularly vulnerable to such lifestyle modifications, were significantly impacted during the first year of the pandemic. We compared the clinical situation of 354 patients one year before the pandemic and one year after. We found that although metabolic control was indeed worse after the first year of the pandemic and patients presented worse clinical outcomes, the latter was mostly due to non-liver causes, namely COVID-19 itself. Moreover, the care provided to these patients did not worsen during the first year of the pandemic.

(1) Background: Patients with advanced chronic liver disease (ACLD) are living longer with more comorbidities because of improved medical and surgical management. However, patients with ACLD are at increased risk of perioperative morbidity and mortality; (2) Methods: We conducted a comprehensive review of the literature to support a narrative clinical guideline about the assessment of mortality risk and management of perioperative morbidity in patients with ACLD undergoing surgical procedures; (3) Results: Slight data exist to guide the perioperative management of patients with ACLD, and most recommendations are based on case series and expert opinion. The severity of liver dysfunction, portal hypertension, cardiopulmonary and renal comorbidities, and complexity of surgery and type (elective versus emergent) are predictors of perioperative morbidity and mortality. Expert multidisciplinary teams are necessary to evaluate and manage ACLD before, during, and after surgical procedures; (4) Conclusions: This clinical practice document updates the available data and recommendations to optimize the management of patients with advanced chronic liver disease who undergo surgical procedures.

Background & Aims: Etiologic factor removal (ER) drives recompensation and improves portal hypertension in cirrhosis. Esophageal varices (EV) and portosystemic shunts (PSS) have been found in patients despite hepatic venous pressure gradient (HVPG) dropping below 10 mmHg after ER, questioning HVPG accuracy in reflecting true portal pressure in the setting of ER. We aim to evaluate the correlation of HVPG with direct portal pressure (DPP) in patients with persistence of EV after ER despite HVPG

This study identifies the endogenous and exogenous factors that influence whether small coffee-growing households decide to join agricultural cooperatives in South Kivu, a conflict-prone province in the eastern Democratic Republic of Congo (DRC). After a pilot test, data were collected through a cross-sectional survey in the territories of Kabare, Kalehe and Idjwi, and 412 randomly selected small coffee producers, coffee cooperative members and non-members participated in the survey. Geographical representativeness was observed in the distribution of this sample across the three territories. A logit model was applied to determine the main factors of membership. In a challenging context such as the eastern DRC, trust in the leaders and initiators of an agricultural cooperative, the need for small coffee-growing households to build up social capital through the cooperative and the household’s perception of the adequacy of the economic benefits (dividends) to be received were the most significant factors in the decision to join or remain in an agricultural cooperative. Other factors such as the age of the household head, the household’s need to access to agricultural inputs and technical training, and the distance between the plantation and the nearest coffee washing station also had a significant effect on the decision to join a coffee cooperative in the eastern DRC. The results of this study help to clarify the dynamics of rural development and the management of agricultural cooperatives in difficult socioeconomic contexts, such as the eastern DRC. The findings also have implications for actions, strategies and public policies to be adopted by cooperatives, market system development actors and the government to promote social cohesion and improve the living conditions of the rural population through agricultural cooperatives.

El presente artículo tiene como principal objetivo ofrecer una aproximación al papel del sector del vino en general y al de las denominaciones de origen vinícolas, como exponente de cluster a escala territorial, en particular, en relación con la sostenibilidad, partiendo de la limitada información cuantitativa detallada disponible a tales efectos y de la información cualitativa recabada de entrevistas a algunas personas altamente cualificadas vinculadas a esta rama de actividad. Con este propósito, el trabajo se ha estructurado en cuatro apartados. En el primero, de carácter introductorio, se destaca la importancia de la industria agroalimentaria (IAA) española y sus denominaciones de origen, haciendo hincapié en la relevancia del sector vinícola en su seno. En el segundo, se ofrece una caracterización de las principales denominaciones de origen vinícolas, catalogables como sistemas productivos locales (SPLs) o cluster territoriales. En el tercero, se detallan las principales actividades y acciones que, a lo largo de la cadena de valor del sector vitivinícola, tienen favorable incidencia desde el punto de vista de la sostenibilidad. El cuarto y último apartado se dedica al examen de los aspectos más relevantes en torno a la contribución de las regiones y las denominaciones de origen vinícolas al desarrollo sustentable. El trabajo finaliza con las principales conclusiones extraídas de esos cuatro apartados y una serie de consideraciones finales de interés desde la perspectiva del desarrollo local sostenible. Cabe anticipar , en este sentido, la trascendencia de las DOPs para la España rural – ampliamente afectada por la despoblación y el envejecimiento demográfico – sobre todo en aquellos territorios en los que el enoturismo aparece como elemento de diversificación productiva, así como la creciente vinculación entre el mundo del vino y la sostenibilidad ambiental, especialmente visible a través de la proliferación de vinos ecológicos y de certificaciones que implican un claro compromiso con el respeto del medio ambiente, como activo intangible que aporta imagen y prestigio a las bodegas.

Territorial development policies facilitate productive diversification and job creation in rural and urban regions, where local actors manage and market local products. Thus, the connection of localities through urban and entrepreneurial networks helps the firms’ interaction and the development of agrarian, industrial and service products for selling in national and international markets. The creation of polycentric territories through new communication systems facilitate the towns and regions accessibility. Therefore, bottom-up policies and cooperation in times of post-COVID-19 recuperation reduces poverty and helps fight against inequality, permitting future territorial and social development.

El arte de Marko I. Rupnik, uno de los principales artistas al servicio de la Iglesia, no resulta a primera vista asombroso. No es un arte para admirar, sino un arte de la presencia, capaz de poner en diálogo el arte paleocristiano y bizantino con el lenguaje de las vanguardias. Esta investigación se centra en las connotaciones teológicas y antropológicas que se pueden extraer del vía crucis que realizó en 2008, en su Eslovenia natal; unos mosaicos formados exclusivamente por rostros, en los que unos grandes ojos, más allá de interpelar al peregrino, le hablan de la constitución más profunda del ser humano y de la vocación a la que está llamado.

La inclusión socioeducativa efectiva de estudiantes con discapacidad supone para la universidad uno de los grandes retos a los que debe hacer frente, por lo que se requiere la aceptación y el reconocimiento de toda la comunidad universitaria. En este sentido, para dar continuidad a investigaciones precedentes en otros países europeos, se plantea el presente estudio en el contexto portugués con la finalidad de analizar las concepciones que el alumnado tiene acerca de la inclusión de sus compañeros con discapacidad. Los participantes fueron 173 estudiantes de la Facultad de Ciencias de la Educación y Psicología de la Universidad de Minho (Portugal). Los resultados, organizados según las categorías de análisis sobre indicadores de atención a la discapacidad en la universidad, indican una actitud positiva hacia este grupo. No obstante, se pone de manifiesto la necesidad de introducir mejoras relativas a la adaptación de la metodología y recursos, así como sobre la disponibilidad de los medios necesarios para su participación de forma activa en la vida universitaria.

Las Casas de encuentro en Chile son lugares donde las personas adultas mayores acuden durante el día con el objeto de realizar actividades en favor de un envejecimiento activo y en donde se llevan a cabo programas de actividades socioeducativas. Este trabajo ha estudiado la satisfacción de las personas adultas mayores con respecto a la formación que reciben. El diseño de la investigación es de carácter no experimental, descriptivo. El contexto del estudio ha sido la Casa de encuentro de Valparaíso con una participación de 205 personas adultas mayores. Los datos se han obtenido a través de un cuestionario de elaboración ad hoc con una escala de tipo Likert. Los resultados han revelado como hallazgos principales, el alto nivel de satisfacción de las personas adultas mayores, no estando este relacionado con los rasgos sociodemográficos de las personas adultas mayores como género, nivel de instrucción u ocupación previa, y sí con sus expectativas previas. La conclusión general es que estos programas son fuente de satisfacción en las personas adultas mayores, más allá de las competencias singulares que en cada caso pretendan promover en estos, debiendo ser una de las claves que orienten las políticas sociales para el envejecimiento activo que emergen como una necesidad cada vez mayor.

The importance of self-concept and the feeling of belonging to a school have been highlighted in numerous studies as predictors of school success. However, there are hardly any studies that link the relationship between self-concept and the feeling of belonging to the school. Thus, the aim of this study is to analyze the influence of personal and educational self-concept on the feeling of belonging to school, based on the data provided by the PISA 2018 report. To achieve this objective, a correlational methodology based on structural equation modelling has been used. The sample of participants is composed of 35,943 students of Compulsory Secondary Education from different Spanish high schools that participated in the PISA 2018 Report. The results obtained have shown that personal and educational self-concept correlate positively. In addition, both factors were positively related to the feeling of belonging to the educational centre. This study allows us to infer the idea of the existence of a direct and positive correlation between school and personal self-concept and the feeling of belonging, which would allow schools to develop educational intervention programmes with the aim of promoting the student’s self-concept in order for them to feel better integrated into the school.

AimWe describe the effectiveness and safety of the interferon-free regimen ombitasvir/paritaprevir/ritonavir plus dasabuvir with or without ribavirin (OBV/PTV/r ± DSV ± RBV) in a nationwide representative sample of the hepatitis C virus (HCV) monoinfected and human immunodeficiency virus-1/hepatitis C virus (HIV/HCV) coinfected population in Spain.Material and methodsData were collected from patients infected with HCV genotypes 1 or 4, with or without HIV-1 coinfection, treated with OBV/PTV/r ± DSV ± RBV at 61 Spanish sites within the initial implementation year of the first government-driven "National HCV plan." Effectiveness was assessed by sustained virologic response at post-treatment week 12 (SVR12) and compared between monoinfected and coinfected patients using a non-inferiority margin of 5% and a 90% confidence interval (CI). Sociodemographic and clinical characteristics or patients and adverse events (AEs) were also recorded.ResultsOverall, 2,408 patients were included in the intention-to-treat analysis: 386 (16%) were patients with HIV/HCV. Patient selection reflected the real distribution of patients treated in each participating region in Spain. From the total population, 96.6% (95% CI, 95.8-97.3%) achieved SVR12. Noninferiority of SVR12 in coinfected patients was met, with a difference between monoinfected and coinfected patients of -2.2% (90% CI, -4.5% - 0.2%). Only genotype 4 was associated with non-response to OBV/PTV/r ± DSV ± RBV treatment (pConclusionsOur results confirm that OBV/PTV/r ± DSV ± RBV is effective and generally well tolerated in a representative sample of the HCV monoinfected and HCV/HIV coinfected population in Spain within the experience of a national strategic plan to tackle HCV.

The first cultural traces of ancient pottery towns in the Serra de Baturité are presented. The pollen spectrum of sediments reveals a mosaic of moist mountainous vegetation, xerophytes, annual nitrophilous, hygrophilous and bog plants. Useful pollen recovered from ceramic, such as cassava (Manihot type), sweet potatoes (Ipomoea type), cotton (Gossypium type), palm trees and fruitful (Arecaceae, cf. Astronium and Anacardium type), together with pathogenic microfungi corn, cotton and some tubers (Curvularia type, Alternaria, Puccinia type and cf. Ustilago maydis) indicate agricultural and livelihood activities. The coprophilous fungi of humans and other animals (Cercophora type Gelasinospora type and Sordariaceae) reflect the time spent by these groups in the archaeological area. The Gelasinospora fungus also shows the use of fire as fuel for agricultural practices and hunting. These data demonstrate the use of ceramics in funerary and domestic contexts.

The south of Iberia conserves an important group of Palaeolithic rock art sites. The graphisms have been mostly attributed to the Solutrean and Magdalenian periods, while the possibility that older remains exist has provoked extensive debate. This circumstance has been linked to both the cited periods, until recently, due to the transition from the Middle to Upper Palaeolithic in the extreme southwest of Europe as well as the non-existence of some of the early periods of Palaeolithic art documented in northern Iberia. This study presents the results of interdisciplinary research conducted in Las Ventanas Cave. These results enabled us to identify a new Palaeolithic rock art site. The technical, stylistic and temporal traits point to certain similarities with the range of exterior deep engravings in Cantabrian Palaeolithic rock art. Ventanas appears to corroborate the age attributed to those kinds of graphic expression and points to the early arrival of the Upper Palaeolithic in the south of Iberia. Importantly, the results provide information on the pre-Solutrean date attributed to trilinear hind figures. These findings challenge the supposed Neanderthal survival idea at one of the main late Middle Palaeolithic southern Iberian sites (Carigüela) and, due to the parallels between them and an engraving attributed to this period in Gibraltar, it raises the possibility of interaction between modern humans and Neanderthals in the extreme southwest of Europe.