BACKGROUND:Hepatitis C virus (HCV) has significantly impacted people with human immunodeficiency virus (HIV). Harm reduction programs, changing transmission patterns, and direct-acting antivirals (DAAs) have profoundly altered HIV/HCV coinfection trends. This study evaluates HCV prevalence among people with HIV in Spain over 2 decades. METHODS:We conducted 9 cross-sectional studies (2002-2023) in 39-43 centers. Sampled individuals were randomly sampled from people with HIV actively followed up at these centers, with proportional allocation. Main outcomes included the prevalence of anti-HCV antibody and active HCV infection (HCV RNA--positive result). RESULTS:The reference population ranged from 31 800 to 47 006, with sample sizes of 1260-1867. HIV transmission patterns shifted from 2002 to 2023, with injection drug use decreasing from 55% to 21% and the proportion of men who have sex with men increasing from 17% to 46%. HCV seroprevalence fell from 60.8% to 27.4%, and active infection from 46.3% to 0.9%. In the DAA era (2015-2023), active HCV infection dropped by 100% in heterosexuals, 94% in people who inject drugs, and 71% in men who have sex with men. Treatment uptake increased from 23% in 2002 to 99% by 2023 with all-oral DAAs. The prevalence of cirrhosis among active HCV cases peaked at 23.1% in 2015 but fell to 0% by 2021. Among those achieving sustained virologic response, cirrhosis prevalence was 20.4% in 2023. CONCLUSIONS:HIV/HCV coinfection has drastically declined in Spain, with active HCV infection prevalence <1% since 2021. DAAs were pivotal in this achievement. However, cirrhosis remains a concern among those with sustained virologic response. Ongoing surveillance and prevention efforts are essential to sustain these gains and address residual risks.
As the global population ages, especially in low- and middle-income countries, there is an urgent need to rethink how health in older age is understood and addressed. Frailty has long served as a clinical construct to identify vulnerability and guide tailored, specialist care for older people. In 2015, the World Health Organisation introduced the concept of intrinsic capacity (IC) as part of its healthy ageing framework, offering a structured, capacity-based approach to promote functional ability. While conceptually distinct, frailty and IC are complementary. Frailty highlights the need for specialised care in complex cases, whereas IC supports early intervention and prevention across broader populations. This paper explores their differences, areas of overlap and how their integration can support a continuum of care that spans primary to specialist settings. Integrating these concepts connects prevention, health promotion and complex care management. By aligning clinical and public health perspectives, the combined use of frailty and IC offers a holistic, person-centred approach to care system transformation, with the potential to drive coordinated strategies that strengthen both geriatric practice and public health across diverse populations.
Hyperprolactinemia is classically linked to reproductive dysfunction, but emerging evidence suggests an association with metabolic and cardiovascular (CV) risk. This study evaluated sex differences in CV risk factors (CVRFs) and cardiovascular disease (CVD) in patients with hyperprolactinemia. A multicenter, retrospective cross-sectional study was conducted in 449 adult patients (199 men, 250 women) with confirmed hyperprolactinemia from 19 tertiary referral centers in Spain. Clinical, biochemical, and hormonal data were collected and analyzed. The prevalence of CVRFs and CVD was compared between sexes. Associations between serum prolactin levels and CVRFs/CVD were assessed using nonparametric tests, correlation analyses, and multivariable logistic regression. Men had significantly higher serum prolactin levels than women (median 796 [IQR 250–1499] vs. 114 [74.5–224] ng/mL; p < 0.001) and a greater crude prevalence of all major CVRFs (p < 0.001 for all). After adjustment for age, male sex remained independently associated with smoking (OR 2.16; p = 0.007) and hyperlipidemia (OR 1.97; p = 0.031). Serum prolactin levels positively correlated with age, BMI, systolic blood pressure, glucose, total cholesterol, and triglycerides (all p < 0.001). In sex-stratified analyses, prolactin was associated with BMI and lipid profile in men, and with hypertension and hyperlipidemia in women. Prolactin levels were significantly elevated in patients with any form of CVD (p = 0.007), particularly arrhythmias (p = 0.013), while a trend was noted for ischemic heart disease (p = 0.050). Men with hyperprolactinemia exhibit a more adverse cardiometabolic profile, characterized by higher serum prolactin levels and a greater burden of classical CVRFs and CVD. Prolactin concentrations are positively associated with multiple metabolic and CV parameters, with sex-specific patterns suggesting distinct mechanisms of susceptibility and regulation. These findings underscore the importance of incorporating sex and hormonal context into CV risk assessment in patients with hyperprolactinemia.
BACKGROUND:Artificial intelligence (AI) and computerized clinical decision support systems (CDSS) are increasingly applied in intensive care, yet their clinical impact remains uncertain, as most studies focus on model development rather than prospective evaluation. OBJECTIVES:To identify randomized controlled trials (RCTs) evaluating AI-based or CDSS interventions intended to influence real-time decision-making in adult intensive care units (ICUs) and to assess their effects on process and patient-centered outcomes. METHODS:We conducted a systematic review of randomized controlled trials (RCTs). PubMed, Embase, Cochrane CENTRAL, ScienceDirect, and IEEE Xplore were searched from inception to November 2025. Eligible studies evaluated AI-based or CDSS interventions in adult ICU patients. Study quality was assessed using RoB 2 and CONSORT-AI criteria. RESULTS:Ten RCTs were included, enrolling approximately 100,000 adult ICU patients. Five trials evaluated AI-based interventions and five evaluated CDSS. Eight trials showed improvements in at least one process measure, including earlier recognition of deterioration, improved protocol adherence, and physiological stability. However, patient-centered benefits were uncommon. Two trials reported reductions in mortality (a sepsis prediction model and a machine-learning-based early-warning system), while most studies showed no consistent effects on clinical outcomes. Reporting of AI-specific elements-dataset provenance, algorithm versioning, and human-AI interaction-was frequently incomplete. CONCLUSIONS:AI and CDSS interventions in adult ICUs are associated with improvements in process-related outcomes but show limited and inconsistent effects on patient-centered endpoints. These findings highlight a persistent gap between algorithmic innovation and clinical validation and underscore the need for pragmatic randomized trials with improved reporting and integration into clinical workflows.
Depending on the methodology used, the prevalence of restless legs syndrome (RLS) in people with multiple sclerosis (PwMS) ranges from 13 to 65
