Progetti partecipativi per la (ri)costruzione collettiva della Vega de Granada come territorio agricolo periurbano

The impaired condition of agriculture, and of periurban agricultural areas in particular, necessarily requires a switch in the direction imposed by the contemporary metropolitan model, using the opportunities offered by social participation, meant as territorial government ruled by citizenship, as turning point. On the basis of this statement, the Granada metropolitan area, and in particular the irrigated plane (la Vega) that gives it sense and landscape identity, is approached through participatory projects trying to identify conflicts, values and perspectives of a sustainable future for these territories.La situazione deteriorata dell’agricoltura e, in particolare, degli spazi agricoli periurbani, implica la necessità di un cambio di direzione, rispetto a quella imposta dal modello metropolitano contemporaneo, che parta dalle opportunità offerte dalla partecipazione sociale intesa come governo del territorio da parte della cittadinanza. Sulla base di questa premessa si affronta l’area metropolitana di Granada e, in particolare, la piana irrigua che le conferisce senso e identità paesistica (la Vega) utilizzando progetti partecipativi finalizzati all’identificazione dei conflitti, dei valori e delle prospettive di un futuro sostenibile per questo territorio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Activation of Th lymphocytes alters pattern expression and cellular location of VIP receptors in healthy donors and early arthritis patients

Vasoactive Intestinal Peptide (VIP) is an important immunomodulator of CD4+ cells in normal and pathological conditions, which exerts its anti-inflammatory and immunomodulatory actions through VPAC receptors, VPAC1 and VPAC2. Only a decrease in the expression of VPAC1 mRNA on Th cells upon activation has been reported. Thus, the deepening in the knowledge of the behavior of these receptors may contribute to the design of new therapies based on their activation and/or blockade. In this study, we describe the expression pattern, cellular location and functional role of VIP receptors during the activation of human Th cells in healthy conditions and in early arthritis (EA). The protein expression pattern of VPAC1 did not change with the activation of Th lymphocytes, whereas VPAC2 was up-regulated. In resting cells, VPAC1 was located on the plasma membrane and nucleus, whereas it only appeared in the nucleus in activated cells. VPAC2 was always found in plasma membrane location. VIP receptors signaled through a PKA-dependent pathway in both conditions, and also by a PKA-independent pathway in activated cells. Both receptors exhibit a potent immunomodulatory capacity by controlling the pathogenic profile and the activation markers of Th cells. These results highlight a novel translational view in inflammatory/autoimmune diseases.This work was supported by funding of Instituto de Salud Carlos III, Spain, co-financed by FEDER, European Union: RETICS program, Red de Investigación en Inflamación y Enfermedades Reumáticas (RIER) (RD16/0012/0008; RD16/0012/0006; RD16/0012/0011), the projects (PI12/00758, PI14/00477 and PI17/0027),and grant from PI12/00758

Agroecografía Social de la Vega de Granada. Proceso participativo para la (re)construcción colectiva de la Vega de Granada como territorio agrario periurbano

La deteriorada situación de las agriculturas y, en particular, de los espacios agrarios periurbanos, implica la necesidad de un cambio del rumbo impuesto por el modelo metropolitano contemporáneo a partir de las oportunidades que brinda la participación social entendida como el gobierno del territorio por parte de la ciudadanía. Sobre esta premisa se aborda el espacio metropolitano de Granada y en particular la llanura regada que le da sentido e identidad paisajística (la Vega) utilizando proyectos participativos que buscan la identificación de los conflictos, de los valores y de las perspectivas de un futuro sostenible para este territorio. Las principales etapas y frentes de trabajo que se han dado en dichos procesos son los siguientes: 1/ La identificación de la ciudadanía activa. 2/ Las entrevistas: un primer contacto con las gentes de la Vega. 3/ La construcción de mapas de comunidad a través de la transmisión intergeneracional de saberes. 4/ El desarrollo de los canales cortos de comercialización a través de la Investigación-acción participativa