The Andalusian Health Service (Spanish: Servicio Andaluz de Salud, SAS), the government-run health system for the autonomous community of Andalusia, Spain, was created on May 6, 1986, as an autonomous agency attached to the Regional Ministry of Health (Consejería de Salud y Familias) of the Andalusian Autonomous Government. The SAS is part of the decentralised Spanish National Health System, and is funded through the annual budget of the Andalusian Autonomous Community. As of 2019, the agency has more than 104,000 employees, including nurses, doctors, pharmacists, veterinarians, social workers, and administrative and service staff. It manages 50 hospitals and more than 1,500 local clinics, covering all medical specialities and applying a wide range of treatments and procedures. The agency also runs emergency rooms, ambulances and medical transport (including aerial transport), physiotherapy, mental health care, etc. Drugs and prescriptions are subsidized, and people pay a percentage of the price depending on its incomes, with a monthly limit for unemployed and retired pacients.
Background: Chronic kidney disease (CKD) is increasingly prevalent, leading to more patients requiring hemodialysis. Medium cut-off (MCO) membranes, such as the ELISIO™ HX dialyzer, may enhance middle-to-large molecule removal and reduce inflammation compared with conventional high-flux membranes. This study evaluated the efficacy and safety of ELISIO™ HX versus a standard high-flux dialyzer (Toraylight NS-21S) in terms of molecular reduction rate and inflammation. Methods: We performed a single-center, prospective, randomized crossover study with 12 hemodialysis patients, each treated with Toraylight NS-21S and ELISIO™ HX over four weeks. Pre- and post-dialysis levels of urea, creatinine, albumin, creatine kinase, phosphorus, parathyroid hormone, C-reactive protein (CRP), procalcitonin, interleukin 6 (IL-6), and β2-microglobulin were measured. Pre–post differences were assessed using dialyzer analysis, period-effect and carryover analysis, and non-inferiority analysis. Results: ELISIO™ HX was non-inferior to Toraylight NS-21S for creatinine, urea, phosphorus, procalcitonin, and β2-microglobulin. No significant serum albumin changes were observed with either dialyzer. Adverse events were infrequent and comparable between the dialyzers. Conclusions: ELISIO™ HX appears non-inferior to Toraylight NS-21S and suggests good safety and tolerability. These findings should be interpreted with caution given the study’s limited power.
Sleep architecture and continuity deteriorate markedly with aging, yet these changes are frequently approached as isolated sleep disorders rather than as manifestations of systemic biological dysregulation. Accumulating evidence indicates that age-related sleep fragmentation reflects the progressive disruption of interconnected metabolic, inflammatory and circadian networks that are central to the biology of aging. In this context, sleep can be more accurately interpreted as a functional readout of systemic biological coherence and resilience in later life. In this integrative mechanistic review, we synthesize current evidence linking metabolic dysregulation, inflammaging and circadian desynchronization to sleep deterioration in older adults, and propose an integrative conceptual framework structured around three interdependent functional domains: Temporal (circadian organization), Energetic (metabolic flexibility and bioenergetics), and Redox-Neuroimmune (chronic low-grade inflammation and oxidative stress). These domains converge on the AMPK-mTOR-SIRT1 axis, which acts as a central mechanistic hub coordinating energy sensing, inflammatory tone and molecular clock regulation. Within this framework, sleep deterioration is conceptualized not as a primary pathological entity, but as the downstream functional expression of impaired nocturnal cellular maintenance driven by reduced AMPK activity, persistent mTOR signalling and declining SIRT1-dependent regulation. Bidirectional feedback loops are considered, whereby sleep fragmentation may further exacerbate metabolic and inflammatory dysregulation, reinforcing loss of biological coherence with aging. Importantly, we explicitly address current methodological limitations, particularly the challenges of assessing AMPK-mTOR-SIRT1 activity in humans using non-invasive approaches. Rather than offering prescriptive therapeutic recommendations, this framework is intended as a mechanistic, hypothesis-generating model to guide future research, biomarker development and translational studies focused on metabolic-circadian resilience and biological aging.
The “surprise question” (“Would I be surprised if the patient died within the next 12 months?”) is useful to predict the survival of patients and indicate the requirement for further assessment of their palliative care needs. Knowledge of the factors related to healthcare professionals’ response is important to establish the effectiveness of this question to screen for PC needs. The aim of this study is to determine if PC needs, frailty, survival prognosis, complexity, symptom burden, and psychological distress are related to the response of advanced practice nurses to the Surprise Question in a sample of complex chronic patients under primary care. Descriptive cross-sectional study. Advanced practice nurses at eight primary care centers in Andalucia (Spain) randomly selected complex chronic patients aged over 18 years and not enrolled in a PC program. Palliative Care needs (NECPAL-ICO-CCOMS 3.1); symptom burden (Edmonton Symptom Assessment Scale), emotional distress (Detection of Emotional Distress tool); frailty (Frail-VIG); prognosis (Palliative Prognostic Index and PROFUND); and complexity (Charlson Multimorbidity Index, Complex Case Evaluation and Palliative Complexity Index) were evaluated among groups with positive and negative surprise question using bivariate analyses. Multiple regression analyses were conducted to identify predictors of a positive surprise question. The study included 179 patients with mean ± standard deviation age of 80.5 (SD = 9.78) years; 54.8
Background: Chronic kidney disease (CKD) is associated with early disturbances in mineral metabolism that contribute to bone fragility. Secondary hyperparathyroidism is a key component of chronic kidney disease-mineral and bone disorder (CKD-MBD) and may affect bone even during the early stages of CKD. This study evaluated the association between serum parathyroid hormone (PTH) concentrations and bone mineral density (BMD) in patients with stage 3 CKD. Methods: A multicenter cross-sectional observational study was conducted in 203 patients with stage 3 CKD. Blood and 24 h urine samples were collected to measure creatinine, calcium, phosphate, magnesium, 25-hydroxyvitamin D, fibroblast growth factor 23 (FGF23), and PTH. Bone mineral density was assessed by dual-energy X-ray absorptiometry (DXA). Associations between serum PTH concentrations and BMD were analyzed. Results: Elevated serum PTH concentrations were associated with lower femoral BMD and less favorable femoral T-scores, whereas no significant associations were observed at the lumbar spine. Serum PTH concentrations were inversely correlated with femoral BMD and femoral T-scores. Patients with reduced femoral BMD also showed higher FGF23 concentrations and lower renal function, while serum calcium, phosphate, magnesium, and 25-hydroxyvitamin D concentrations did not differ significantly among the groups. Conclusions: Elevated serum PTH concentrations were associated with reduced femoral BMD in patients with stage 3 CKD, supporting preferential early involvement of cortical bone. Serum PTH may represent an accessible biomarker for the early identification of patients at increased risk of cortical bone loss before conventional biochemical abnormalities become clinically apparent.
BackgroundTeledentistry is key to achieving equitable healthcare, especially in rural areas. According to the Global Strategy for Oral Health, the use of digital technologies such as video consultations (VCs) makes it possible to overcome geographical barriers, facilitating access to basic services and early detection of diseases.AimTo analyse the implementation of video consultations for oral health and patient satisfaction level at Primary Health Care in rural areas.MethodDescriptive study in adult patients in rural areas of Andalusia (Spain). The intervention was carried out using virtualisation platforms and systems integrated within the Andalusian Public Health System of the Andalusian Health Service (SSPA), ensuring confidentiality. Professionals received prior training through clinical simulation to ensure adequate and humanised performance in remote care.ResultsThe use of VCs in primary care showed high effectiveness and overall satisfaction, with 78.6% of consultations being finalised and a high level of patient satisfaction (9). Most patients only required one video consultation (VC) (76.8%). However, significant digital divides were identified, with results showing significant differences between connection groups (p-value < 0.001), with those over 55 being the most affected group, as well as 90% of those who needed external help to connect and 50% of those who had connection problems.ConclusionVideo consultations in dentistry are a valuable tool for rural primary care, improving accessibility and efficiency. Social support is a key to overcome technological difficulties which face older user.
