BACKGROUND:To assess the long-term (12-month) effects of computerized cognitive stimulation versus stimulating leisure activities in adults with subjective cognitive impairment (SCI) and mild cognitive impairment (MCI). METHODS:A 12-month follow-up of a single-blind randomized controlled trial was conducted in primary care centres in Zaragoza, Spain, including 50 adults aged = 50 years with SCI or MCI. Participants were allocated to one of three groups: the computerized cognitive stimulation group (IG1, n=18), the stimulating leisure activities group (IG2, n=16), or a control group (CG, n=16). The primary outcome was global cognitive function; secondary outcomes included memory, verbal fluency, activities of daily living, and mood. Effect sizes were calculated using bootstrapped partial eta-squared (?2p) Results. At 12 months, significant between-group differences were observed in depressive symptoms according to the GDS-15 score (p = 0.005, ?2p = 0.209) and anxiety levels measured by the Goldberg Index score (p < 0.001, ?2p = 0.295). Both intervention groups (IG1 and IG2) showed sustained improvements in depressive symptoms, while anxiety levels remained stable in the intervention groups and worsened in the CG. CONCLUSIONS:Participation in computerized cognitive stimulation or stimulating leisure activities associates with sustained, long-term improvements in depressive symptoms and levels of anxiety, supporting the effectiveness of non-pharmacological interventions in primary healthcare.
BACKGROUND:This study examined the association between empathy and compassion fatigue among nurses working in neonatal and pediatric intensive care units. METHODS:A cross-sectional study was conducted among nurses employed in neonatal and pediatric intensive care units at three hospitals in Turkey. Sociodemographic and occupational data were collected, and participants completed the Jefferson Scale of Empathy and the Compassion Fatigue Short Scale. Pearson´s correlation and linear regression analyses were performed to examine the association between empathy, compassion fatigue, and other study variables. RESULTS:Sixty-five nurses participated in the study, representing 90.3% of the target population. Mean empathy and compassion fatigue scores were 79.77 ± 8.69 and 52.09 ± 20.44, respectively. A moderate positive correlation was observed between empathy and compassion fatigue (r = 0.484). Empathy explained 22.2% of the variance in compassion fatigue (R² = 0.222; B = 1.139; 95% CI: 0.621 - 1.657; p < 0.001). Nurses who had voluntarily chosen nursing reported significantly lower compassion fatigue scores than those who had not (49.14 ± 19.39 vs 61.93 ± 21.42; p = 0.032). Working more than 50 hours per week was associated with higher empathy scores (84.06 ± 11.58 vs 78.82 ± 6.46; p = 0.046), but not with compassion fatigue. CONCLUSIONS:Higher empathy associates with greater compassion fatigue among nurses working in neonatal and pediatric intensive care units. Voluntarily choosing nursing associates with lower compassion fatigue, whereas longer working hours associate with higher empathy.
El síndrome Charcot-Marie-Tooth tipo X1 (CMTX1) es una neuropatía motora y sensitiva hereditaria, causada por mutaciones en el gen GJB1 del cromosoma X. Aunque infrecuentes, la literatura describe cuadros tipo stroke mimic en pacientes CMTX1 en relación a episodios de estrés, con hallazgos característicos en la resonancia magnética y resolución espontánea completa. Presentamos el caso de un adolescente varón de 13 años con CMTX1, sin clínica neurológica previa, que tras picadura de avispa presentó cuadro de hemiparesia derecha, disartria y desviación bucal. Tras activación del código ictus, la resonancia magnética cerebral mostró lesiones hiperintensas bilaterales en centros semiovales, sin signos de trombosis. Sería el primer caso en un paciente pediátrico con CMTX1 con picadura de insecto como desencadenante del cuadro que mimetizó un ictus. Consideramos la importancia de, ante la duda, activar el código ictus pediátrico y realizar resonancia magnética para confirmar el diagnóstico y descartar otros procesos.
Fundamento. La introducción de la vacunación contra la viruela a comienzos del siglo XIX supuso uno de los principales avances en la historia de la salud pública en España. Aunque su difusión inicial ha sido estudiada principalmente desde las iniciativas institucionales, se conoce menos el papel de los médicos locales en su implantación. Material y métodos. Se realizó un estudio histórico-documental basado en el análisis de fuentes primarias (archivos, prensa histórica y memorias médicas) y secundarias, centrado en la trayectoria del médico navarro Manuel Gil y Albéniz (1767-1849), titular de Cascante (Navarra). Resultados. Gil y Albéniz inició la vacunación contra la viruela en Cascante en 1801, en una fase temprana de su introducción en España. Desarrolló una intensa actividad como vacunador, alcanzando centenares de vacunaciones y contribuyendo a la difusión del material vacunal en Navarra. Sus escritos documentan métodos de conservación y transmisión de la vacuna, así como estrategias para mantener la vacunación durante la Guerra de la Independencia. Participó en redes científicas nacionales como socio corresponsal de la Real Academia de Medicina de Barcelona y de la Sociedad Médico-Quirúrgica de Cádiz. En 1820 publicó la Colección de memorias médicas, que recoge sus principales observaciones. Conclusiones. Manuel Gil y Albéniz puede considerarse uno de los introductores tempranos de la vacunación en Navarra. Su trayectoria ilustra el papel de los médicos locales en la difusión de la vacuna y en la consolidación inicial de las prácticas de salud pública en la España del siglo XIX.
Deep neck infections in pediatric patients are increasingly frequent and may lead to severe complications due to nonspecific early symptoms. We report the case of a 12-month-old infant who developed a parapharyngeal abscess with mediastinal extension following accidental fish bone ingestion, requiring combined surgical and conservative management with favorable outcome. The primary aim of this article is to present a representative clinical case to describe clinical presentation, physical examination, diagnostic evaluation, treatment, clinical course, and follow-up of this condition. Additionally, this study reviews the available literature to compare different diagnostic and therapeutic approaches and contrast them with our clinical practice, providing practical guidance to support the management of similar cases in the future.
BACKGROUND:Non-attendance at hospital outpatient clinics disrupts continuity of care and reduces healthcare efficiency, particularly in high-demand specialties. This study analyzes patient-reported reasons for non-attendance at otolaryngology (ENT) outpatient clinics, classifies them according to their potential avoidability, and assesses the frequency of subsequent appointment rescheduling. METHODS:A retrospective observational study was conducted at a secondary-level public hospital. Among 1,117 missed outpatient appointments recorded in 2024, a random sample of 299 was selected. Structured telephone interviews were carried out between February and June 2025. Reasons for non-attendance were categorized using a predefined classification and grouped as avoidable or unavoidable. Descriptive analyses were performed, together with ?² and Mann-Whitney U tests. Open-ended responses underwent descriptive thematic analysis and were mapped to the dimensions of Levesque's access-to-care framework. RESULTS:The final analyses included 232 appointments (77.5%). Failure to receive appointment notification was the most frequently reported reason for non-attendance (32.3%), followed by work-related or personal scheduling conflicts (19.4%). Overall, 42.2% of missed appointments were considered potentially avoidable, whereas only 25.0% of them were subsequently rescheduled. Neither avoidability nor rescheduing was associated with age, sex, or nationality. The approachability dimension accounted for 44.6% of all reported reasons. CONCLUSIONS:Non-attendance at ENT outpatient clinics is largely attributable to potentially modifiable factors, particularly failures in the appointment notification process. Despite missed appointments, only one quarter of patients subsequently rescheduled their appointment.
Introducción. La pauta habitual de linezolid se asocia con exposición subóptima en pacientes críticos. En este estudio se analiza la asociación entre las distintas modalidades de tratamiento (dosis, tiempo de infusión) y la probabilidad de alcanzar los objetivos farmacocinéticos/farmacodinámicos, evaluando su impacto microbiológico y clínico. Pacientes y métodos. Estudio retrospectivo en pacientes ingresados en unidades de cuidados intensivos con monitorización terapéutica de linezolid entre mayo de 2021 y diciembre de 2023. Se analizó el cumplimiento de los objetivos farmacocinéticos/farmacodinámicos (Cmin: 2-7 mg/L, AUC: 0–24/CMI: 80–120 mg*h/L, y T>CMI ≥85%) en función de la pauta inicial (1.200 o 1.800 mg/día) y tiempo de infusión (1 o 3 h). Se analizaron subgrupos de riesgo: obesidad, aclaramiento de creatinina aumentado, técnicas de reemplazo renal y <65años Resultados. Se incluyeron 70 pacientes. En la primera monitorización, el 18,6% alcanzó los tres objetivos farmacocinéticos/farmacodinámicos y el 40% tuvo la Cmin en rango. No hubo diferencias estadísticamente significativas en la consecución de objetivos según la pauta o el tiempo de infusión (tampoco en subgrupos de riesgo). Sin embargo, el cumplimiento de Cmin fue superior con la dosis de 1.800 mg/día (54,5% vs. 37,3%). Tampoco se detectaron diferencias significativas respecto a resultados microbiológicos y clínicos según Cmin estuviese en rango o no. Conclusiones. Menos del 20% de pacientes alcanzó todos los objetivos farmacocinéticos/farmacodinámicos con la pauta inicial. Estos resultados sugieren la necesidad de individualizar y monitorizar las pautas para optimizar el tratamiento en esta población, especialmente en perfiles de riesgo.
Fundamento. Dada su capacidad de respuesta inmediata, los efectivos de la Guardia Civil representan un recurso esencial en la reanimación cardiopulmonar extrahospitalaria, especialmente en contextos rurales o de difícil acceso. Este estudio tiene como objetivo evaluar la calidad técnica de reanimación cardiopulmonar tras una intervención formativa y su relación con las variables antropométricas. Material y métodos. Estudio cuasiexperimental con medidas repetidas, sin grupo control, en el que participaron 41 efectivos de la Sección de Intervención Rápida de la Guardia Civil. Se recogieron variables sociodemográficas, antropométricas, y de calidad de la reanimación cardiopulmonar, incluyendo el total score (0-100 puntos) compuesto por compresion score, flow fraction y ventilation score. La intervención en simulación (maniquí) se basó en las directrices del Consejo Europeo de Resucitación. Resultados. Solo una participante era mujer. La mediana de IMC fue de 27,4 kg/m² y el 70,7% presentó un porcentaje de grasa corporal ≥25%. Tras la intervención, se observaron mejoras estadísticamente significativas en el total score mediano (64 a 93 puntos), el porcentaje de ventilaciones correctas (33 a 90%), la relación compresión/ventilación (12,2 a 46,3%) y la velocidad media de compresiones (134 a 109/min). La estatura mostró una asociación negativa con el desempeño post-intervención en el modelo ajustado (β= -1,024; p=0,001). Conclusiones. La intervención mejoró significativamente la calidad de la reanimación cardiopulmonar. La estatura influyó negativamente en el rendimiento mientras que la proporción de grasa corporal no se asoció con el desempeño. Las asociaciones con variables antropométricas deben interpretarse con cautela.
Fundamento. Determinar si hubo desigualdades en la mortalidad por todas las causas y por COVID-19 en las residencias de personas mayores entre las áreas de salud de Castilla-La Mancha durante 2020, y si estas desigualdades se explican por la incidencia de COVID-19 en el municipio correspondiente. Métodos. Los datos de las residencias proceden del Portal de Transparencia de Castilla-La Mancha. Las residencias se clasificaron según área de salud, tamaño, gestión e incidencia de COVID-19 en el municipio. Utilizando regresión de Poisson, se estimaron las razones de riesgo de mortalidad por todas las causas y por COVID-19 según área de salud, considerando Toledo como referencia, ajustando por tamaño, gestión e incidencia municipal de COVID-19. Resultados. Las 310 residencias (25.150 plazas) informaron 4.460 defunciones (2.821 por COVID-19). La mortalidad por todas las causas varió entre el 7% en las residencias de Talavera y el 26% en las de Ciudad Real. La mortalidad por COVID-19 varió entre el 4% en las de Puertollano y el 17% en las de Ciudad Real. En el modelo ajustado, las residencias en Ciudad Real, Guadalajara, Albacete y Puertollano tuvieron mayor riesgo de mortalidad por todas las causas que las de Toledo, y las Talavera, un riesgo menor. Las residencias de Albacete tuvieron mayor riesgo de mortalidad por COVID-19 que las de Toledo Conclusión. En 2020 se confirmaron las desigualdades territoriales en el riesgo de morir en las residencias de mayores de Castilla La Mancha, solo parcialmente explicadas por la incidencia local de COVID-19.
Fundamento. Este estudio compara la eficiencia de un mismo hospital bajo gestión privada (2015–2018) y pública (2019–2022), evaluando el impacto del periodo pandémico (2020–2021). Metodología. La eficiencia hospitalaria se evaluó mediante un modelo de análisis envolvente de datos, orientado a outputs y con retornos variables a escala. Las consultas, urgencias, intervenciones quirúrgicas, ingresos hospitalarios y estancias se incluyeron como outputs, considerando un input constante (=1). La robustez se analizó con un bootstrap paramétrico de 1.500 réplicas, generando intervalos de confianza e indicadores corregidos por sesgo. Además, se aplicó un análisis de series temporales interrumpidas para proyectar un escenario contrafactual del periodo de gestión privada y compararlo con el de gestión pública. Resultados. La gestión privada alcanzó consistentemente niveles de eficiencia cercanos a la frontera durante 2015–2018. La gestión pública mostró una caída abrupta en 2020–2021, con valores de eficiencia próximos a cero. El análisis bootstrap confirmó que estas reducciones fueron estadísticamente significativas y no aleatorias. En 2022 se observó una recuperación parcial, aunque los niveles de eficiencia se mantuvieron por debajo del escenario contrafactual proyectado. Conclusiones. Mientras la gestión privada mostró una eficiencia hospitalaria estable, la pandemia impactó negativamente la gestión pública, con signos de resiliencia en la etapa post-pandémica inmediata. La eficiencia hospitalaria es altamente sensible a las crisis externas y a las estructuras de gobernanza. Fortalecer la resiliencia, la digitalización y la sostenibilidad constituye una estrategia clave para mantener la eficiencia y la equidad en futuras disrupciones del sistema.
Charcot-Marie-Tooth syndrome type X1 (CMTX1) is an inherited motor and sensory neuropathy caused by mutations in the GJB1 gene located in the X chromosome. Although uncommon, stroke-like episodes have been reported in patients with CMTX1, typically triggered by stress and characterized by distinctive magnetic resonance imaging findings with complete spontaneous resolution. We report the case of a 13-year-old boy with CMTX1 and no prior neurological symptoms who developed right hemiparesis, dysarthria, and facial deviation following a wasp sting. After activation of the stroke code, brain magnetic resonance revealed bilateral hyperintense lesions in the centrum semiovale without evidence of thrombosis. To our knowledge, this is the first paediatric case of CMTX1 in which an insect sting acted as a trigger, mimicking stroke. Prompt activation of stroke protocols and neuroimaging is essential to establish the diagnosis and exclude other conditions.
BACKGROUND:The introduction of smallpox vaccination in the early nineteenth century marked a major milestone in the history of public health in Spain. Although its early dissemination has been mainly studied from an institutional perspective, the contribution of local physicians to its implementation remains less well understood. METHODS:Historical study based on documentary sources conducted using primary sources, including archival records, historical newspapers, and medical memoirs, together with relevant secondary literature. The study focuses on the career of the Navarrese physician Manuel Gil y Albéniz (1767-1849), who practised in the town of Cascante (Navarre). RESULTS:Gil y Albéniz introduced smallpox vaccination in Cascante in 1801, during the early stage of its adoption in Spain. He carried out hundreds of vaccinations and played an important role in disseminating vaccine material throughout Navarre. His writings describe methods for preserving and transmitting vaccine material and document strategies that enabled vaccination to continue during the Peninsular War. He also participated in scientific networks as a corresponding member of the Royal Academy of Medicine of Barcelona (1803) and the Medical-Surgical Society of Cádiz (1820). His Colección de memorias médicas (1820) brings together his principal clinical observations. CONCLUSIONS:Manuel Gil y Albéniz was among the earliest physicians to introduce smallpox vaccination in Navarre. His career highlights the important contribution of local physicians in the dissemination of vaccination and the early development of public health in nineteenth-century Spain.
Intravesical instillation of Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, is the standard adjuvant treatment following transurethral resection of intermediate- and high-risk non-muscle-invasive urothelial carcinoma. Its therapeutic effect relies on intense local immune activation, reducing recurrence and progression rates and thereby improving patient outcomesand quality of life. Although generally well tolerated, both local and systemic infections and inflammatory complications may occur. We report a case of central nervous system BCG dissemination following intravesical BCG immunotherapy. The insidious onset and non-specific neurological manifestations complicated the diagnostic process and delayed the initiation of appropriate treatment. This case highlights the importance of thorough medical history assessment and maintaining a high index of suspicion in patients presenting neurological symptoms after intravesical BCG therapy.
Intrahepatic cholangiocarcinoma is a poor prognosis malignancy with limited therapeutic options in advanced stages. Identification of actionable molecular alterations may enable targeted therapies in selected patients. We describe a 74-year-old man with metastatic intrahepatic cholangiocarcinoma harboring a BRAF V600E mutation, treated off-label in the second-line setting with dabrafenib (150 mg twice daily) plus trametinib (2 mg once daily) after progression on platinum-based chemotherapy. Treatment resulted in stable disease, a reduction in CA 19-9, and mild adverse events. Progression-free survival was 12.8 months and overall survival reached 44.4 months. This case underscores the importance of early molecular profiling and supports the integration of targeted therapies into routine clinical practice for tumors with limited effective therapeutic options.
BACKGROUND:This study evaluates the efficiency of a hospital under two management models, private (2015-2018) and public (2019-2022), and examines the impact of the COVID-19 pandemic (2020-2021). METHODS:Hospital efficiency was evaluated using an output-oriented data envelopment analysis model with variable returns to scale. Outputs included consultations, emergency visits, surgical procedures, admissions, and inpatient stays, assuming a constant input (=1). Robustness was assessed using a parametric bootstrap (1,500 replications) to obtain bias-corrected efficiency scores and confidence intervals. An interrupted time series analysis was conducted to estimate a counterfactual scenario under continued private management and compare it with observed outcomes under public management. RESULTS:Efficiency under private management remained consistently close to the frontier during 2015-2018. Under public management, efficiency declined sharply during the pandemic, reaching near-zero values in 2020-2021. Bootstrap results confirmed that these reductions were statistically significant and not random. A partial recovery was observed in 2022; however, efficiency remained below counterfactual projections. CONCLUSIONS:While efficiency performed stably under private management, the public model was markedly affected by the pandemic, though showing signs of resilience thereafter. These findings highlight the sensitivity of hospital efficiency to external crises and governance structures, underscoring the need to strengthen resilience, digitalization, and sustainability to maintain efficiency and equity in future health system disruptions.
Background. Consulta Joven is a community intervention developed in primary care to address adolescents´ health needs. It offers open health consultations in secondary schools within a context of trust and confidentiality and is complemented by additional health promotion activities. This study explores the perceptions of professionals involved in the programme regarding challenges and key elements influencing its implementation. Methods. A qualitative, descriptive-interpretive approach study was conducted in primary care in Mallorca (Spain) in 2017. Participants were recruited by Consulta Joven coordinators using purposive theoretical sampling. Three focus groups were conducted with ten nurses, four physicians, and six teachers. Two researchers independently coded transcripts using a general inductive approach. Categories were developed through content analysis and refined through team discussion. Results. Four categories emerged: Perceived value and usefulness of Consulta Joven, Barriers to implementation, Key elements for programme development, and Proposals for improvement. Participants described Consulta Joven as an effective strategy to reach adolescents, promote healthy behaviours, and identify health problems before they seek medical care. Trust and confidentiality are highlighted as essential for its success, along with intersectoral collaboration with community stakeholders. Conclusions, Professionals perceive Consulta Joven as a useful intervention to adolescent health promotion. Strengthening institutional support and collaboration between the health and education sectors, and introducing the programme at earlier educational stages, may enhance its preventive impact.
Background. To assess whether inequalities existed across the eight health areas of Castilla-La Mancha (Spain) in all-cause and COVID-19 mortality in long-term care homes during 2020, and whether these differences were explained by COVID-19 incidence in the corresponding health areas. Methods. Data were obtained from the Castilla-La Mancha Transparency Portal. Care homes were classified by health area, size, ownership, and COVID-19 incidence at the health-area level. Poisson regression models were used to estimate risk ratios for all-cause and COVID-19 mortality in each health area, using Toledo as the reference, and adjusting for size, ownership, and health-area COVID-19 incidence. Results. Among 310 care homes (25,150 places), 4,460 deaths were recorded, including 2,821 attributed to COVID-19. All-cause mortality ranged from 7% in care homes in Talavera to 26% in those in Ciudad Real, while COVID-19 mortality ranged from 4% in care homes in Puertollano to 17% in care homes in Ciudad Real. In adjusted analyses, care homes in Ciudad Real, Guadalajara, Albacete, and Puertollano had higher all-cause mortality risk than those in Toledo, whereas those in Talavera showed lower risk. Only care homes in Albacete showed higher risk of COVID-19 mortality compared with those in Toledo. Conclusions. Substantial territorial inequalities in mortality risk are observed in long-term care homes in Castilla-La Mancha for 2020. These inequalities were only partially explained by the community incidence of COVID-19.
Obesity is a highly prevalent and complex condition with biomedical, psychological, and social dimensions that pose major challenges for healthcare systems. Beyond its clinical consequences, people living with obesity frequently experience weight-based discrimination in healthcare settings, undermining care quality and equity. This paper examines key mechanisms underlying obesity-related stigma among healthcare professionals, including attribution of excess weight to individual responsibility and the internalization of stigma by patients. Drawing on current evidence, it analyses how negative attitudes of healthcare professionals contribute to suboptimal clinical interactions, inadequate care environments, and reduced patient engagement. These processes may weaken the therapeutic relationship, hinder treatment adherence, and negatively affect physical and mental health outcomes. Addressing obesity stigma requires targeted professional training, adaptation of care environments, and inclusive health policies to ensure equitable and respectful care for this population.
