Dikkat Eksikliği/Hiperaktivite Bozukluğu (DEHB) yaygın bir nörogelişimsel bozukluktur. Son yıllarda, nöroinflamatuar süreçlerin DEHB'nin biyolojik temellerindeki potansiyel rolüne olan ilgi artmaktadır. Bu çalışma, DEHB olan ergenler ile bir kontrol grubu arasında serum HMGB1 ve hs-CRP düzeylerini karşılaştırmayı ve HMGB1'in DEHB semptom boyutları ile olan ilişkilerini incelemeyi amaçlamaktadır. DEHB grubunda HMGB1 düzeyleri, kontrol grubuna göre anlamlı derecede düşüktü (ortalama fark = −15,20 ng/mL, p < 0,001). Ayrıca, HMGB1 düzeyleri ASSQ iletişim sorunları ile pozitif korelasyon gösterdi. Sonuçlar, DEHB'de serum HMGB1 düzeylerinin önemli bir rol oynayabileceğini düşündürmektedir.
Arka plan: İş yerlerinin hızlı dijitalleşmesi, örgütsel süreçleri ve iletişim modellerini dönüştürerek çalışanlar için yeni psikososyal riskler oluşturmuştur. Bu gelişmekte olan riskler arasında teknostres, önemli bir iş sağlığı sorunu haline gelmiştir. Bununla birlikte, geniş çalışan popülasyonlarında teknostresin sosyodemografik ve yaşam tarzı belirleyicilerine ilişkin kanıtlar sınırlı kalmaya devam etmektedir. Amaç: İspanyol çalışanlardan oluşan geniş bir kohortta sosyodemografik özellikler, yaşam tarzı faktörleri ve yüksek teknostres arasındaki ilişkiyi incelemek. Yöntemler: Ocak 2021 ile Aralık 2024 tarihleri arasında rutin iş sağlığı muayenelerinden geçen 102.878 İspanyol çalışandan elde edilen veriler kullanılarak kesitsel bir çalışma yürütülmüştür. Teknostres, Teknostres Kısa Anketi (TCS-Short) kullanılarak değerlendirilmiştir. Sosyodemografik değişkenler cinsiyet, yaş, eğitim düzeyi ve sosyal sınıfı içermiştir. Yaşam tarzı değişkenleri fiziksel aktivite, Akdeniz diyetine uyum ve sigara içme durumunu kapsamıştır. Yüksek teknostres ile ilişkiler çok değişkenli lojistik regresyon modelleri kullanılarak değerlendirilmiş ve %95 güven aralıkları (GA) ile düzeltilmiş olasılık oranları (OR) hesaplanmıştır. Bulgular: Orta düzey teknostres en sık görülen kategori (%46,6) olmuş, bunu düşük (%23,3), yüksek (%22,0) ve çok yüksek teknostres (%8,2) izlemiştir. Genel olarak, çalışanların %30,1'i yüksek veya çok yüksek teknostrese sahip olarak sınıflandırılmıştır. Kadın çalışanlar, erkeklere göre anlamlı derecede daha düşük yüksek teknostres olasılığı göstermiştir (OR = 0.15; %95 GA 0.14–0.16). Belirgin bir yaşa bağlı gradyan gözlenmiş olup, 60–69 yaş arası çalışanlar 20–29 yaş arası olanlara kıyasla önemli ölçüde daha yüksek olasılık göstermiştir (OR = 84.52; %95 GA 73.48–97.23). Ortaöğretim ve üniversite eğitimi, daha düşük yüksek teknostres olasılığı ile bağımsız olarak ilişkilendirilmiştir (sırasıyla OR = 0.60 ve OR = 0.34). Sosyal sınıf III, artan teknostres olasılığı ile ilişkilendirilmiştir (OR = 1.53; %95 GA 1.26–1.87). Düzenli fiziksel aktivite (OR = 0.14; %95 GA 0.13–0.15) ve Akdeniz diyetine uyum (OR = 0.41; %95 GA 0.38–0.44) güçlü koruyucu faktörler olarak ortaya çıkmıştır. Sigara kullanımı mütevazı bir ters ilişki göstermiştir (OR = 0.83; %95 GA 0.80–0.87). Sonuçlar: Teknostres, İspanyol çalışanların neredeyse üçte birini etkilemekte olup sosyodemografik ve yaşam tarzı özellikleri ile güçlü bir şekilde ilişkilidir. İleri yaş, erkek cinsiyet, daha düşük eğitim düzeyi ve daha düşük sosyal sınıf, yüksek teknostres olasılığının artmasıyla ilişkilendirilirken, fiziksel aktivite ve Akdeniz diyetine uyum önemli koruyucu etkiler göstermiştir. Bu bulgular, dijital risk yönetimini giderek dijitalleşen iş yerlerinde iş sağlığı geliştirme stratejileri ile entegre etmenin önemini vurgulamaktadır.
Introducción: Los dispositivos de acceso venoso central constituyen un elemento fundamental en el tratamiento de pacientes oncológicos y hematológicos. Sin embargo, la evidencia disponible sobre las complicaciones asociadas a los catéteres centrales de inserción periférica (PICC) y a los reservorios venosos totalmente implantables (Port-a-Cath®) continúa siendo heterogénea. Objetivo: Comparar la incidencia de complicaciones asociadas a PICC y Port-a-Cath® en pacientes oncológicos y hematológicos atendidos en un hospital universitario. Método: Estudio observacional analítico retrospectivo realizado en pacientes adultos portadores de PICC o Port-a-Cath® entre abril de 2023 y marzo de 2024. Se analizaron complicaciones relacionadas con el dispositivo, incluyendo infecciones y obstrucciones intraluminales. Se calcularon riesgos relativos, odds ratios e incidencias por 1000 días-catéter. Asimismo, se realizó un análisis de regresión logística binaria de carácter exploratorio. Resultados: Se incluyeron 509 pacientes, 71 portadores de PICC y 438 de Port-a-Cath®. Se registraron 49 complicaciones (9,6%), de las cuales 27 correspondieron a infecciones y 22 a obstrucciones. La incidencia de complicaciones fue del 14,1% en los PICC y del 8,9% en los Port-a-Cath® (OR 1,68; IC95%: 0,80-3,53; p=0,174). En el análisis por tiempo de exposición, la densidad de incidencia fue de 2,29 complicaciones por 1000 días-catéter (IC95%: 1,05-4,34) en los PICC y de 0,14 por 1000 días-catéter (IC95%: 0,07-0,24) en los Port-a-Cath®. Conclusiones: Los pacientes portadores de PICC presentaron una mayor incidencia acumulada de complicaciones y una mayor densidad de incidencia por 1000 días-catéter que los portadores de Port-a-Cath®. No obstante, las diferencias observadas no alcanzaron significación estadística. La interpretación de los resultados debe realizarse con cautela debido al sesgo de indicación y al carácter observacional retrospectivo del estudio.
Background: H. pylori is known for its role in gastric carcinogenesis, but its potential association with colorectal neoplasia remains incompletely understood. Objective: We evaluated the relationship between H. pylori-associated inflammatory changes in histopathology and colorectal polyps in a symptomatic tertiary-care cohort. Methods: This cross-sectional study included 139 patients undergoing both gastroscopy and colonoscopy. Gastric and colonic biopsies were evaluated according to the updated Sydney System and WHO histopathologic criteria. Multivariate logistic regression analyses adjusted for age and gender were performed to explore associations between gastric pathology and colorectal neoplastic outcomes. Results: H. pylori-positive patients had a significantly higher prevalence of colorectal polyps compared to uninfected individuals (OR 5.98, 95% CI 2.68-13.35; p <0.001), and the association remained significant after age adjustment (adjusted OR 4.85, 95% CI 2.11-11.16, p <0.001). H. pylori infection was independently associated with colorectal adenomas (adjusted OR 3.31; 95% CI 1.22-9.00; p=0.019). Premalignant gastric changes, including atrophy and intestinal metaplasia, were associated with increased risk of colorectal polyps (OR 4.12; 95% CI 1.12–15.24; p = 0.036). Conclusions: H. pylori-associated gastric inflammatory and premalignant histopathological changes were associated with a higher prevalence of colorectal neoplastic lesions in this tertiary-care cohort. These findings support the hypothesis that cumulative gastric inflammatory burden may be linked to colorectal neoplasia, although larger prospective multicenter studies are required for validation.
Background: The rapid digitalization of workplaces has transformed organizational processes and communication patterns, generating new psychosocial risks for employees. Among these emerging risks, technostress has become an important occupational health concern. However, evidence regarding the sociodemographic and lifestyle determinants of technostress in large working populations remains limited. Objective: To examine the association between sociodemographic characteristics, lifestyle factors, and high technostress in a large cohort of Spanish workers. Methods: A cross-sectional study was conducted using data from 102,878 Spanish workers who underwent routine occupational health examinations between January 2021 and December 2024. Technostress was assessed using the Technostress Short Questionnaire (TCS-Short). Sociodemographic variables included sex, age, educational level, and social class. Lifestyle variables comprised physical activity, adherence to the Mediterranean diet, and smoking status. Associations with high technostress were evaluated using multivariable logistic regression models, and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. Results: Moderate technostress was the most frequent category (46.6%), followed by low (23.3%), high (22.0%), and very high technostress (8.2%). Overall, 30.1% of workers were classified as having high or very high technostress. Female workers showed significantly lower odds of high technostress than men (OR = 0.15; 95% CI 0.14–0.16). A marked age-related gradient was observed, with workers aged 60–69 years presenting substantially higher odds than those aged 20–29 years (OR = 84.52; 95% CI 73.48–97.23). Secondary and university education were independently associated with lower odds of high technostress (OR = 0.60 and OR = 0.34, respectively). Social class III was associated with increased odds of technostress (OR = 1.53; 95% CI 1.26–1.87). Regular physical activity (OR = 0.14; 95% CI 0.13–0.15) and adherence to the Mediterranean diet (OR = 0.41;95% CI 0.38–0.44) emerged as strong protective factors. Smoking showed a modest inverse association (OR = 0.83; 95%CI 0.80–0.87). Conclusions: Technostress affects nearly one-third of Spanish workers and is strongly associated with sociodemographic and lifestyle characteristics. Older age, male sex, lower educational attainment, and lower social class were associated with a greater likelihood of elevated technostress, whereas physical activity and adherence to the Mediterranean diet showed significant protective effects. These findings highlight the importance of integrating digital risk management with occupational health promotion strategies in increasingly digitalized workplaces.
Introducción: La implantología oral, como campo científico, ha experimentado un desarrollo significativo en los últimos años, incorporando tecnologías avanzadas, como el uso de nuevos biomateriales y la planificación y el diseño digitales. Sin embargo, su base teórica, la comprensión de la biología de la osteointegración, ha permanecido durante décadas vinculada a estudios pioneros del siglo pasado, interpretados dentro del ámbito de la osteología clásica. En la actualidad, la visión de una interfaz hueso-implante basada en la simple cicatrización ósea alrededor de un elemento “inerte”, el implante, parece insostenible. La evidencia de los últimos años demuestra una interfaz dinámica, con una superficie implantaria activa e inmunomoduladora, y un microambiente periimplantario gobernado por la osteoinmunología del huésped. Objetivos: Conocer/Indagar sobre la relación entre el emergente campo de la osteoinmunología y los implantes orales. Metodología: Se realizó una revisión bibliográfica que incluyó artículos científicos publicados en los últimos diez años e identificados a través de las siguientes fuentes: MEDLINE y Google Scholar. La búsqueda se realizó en inglés. Resultados: Cincuenta y ocho artículos cumplieron los criterios de inclusión. Los artículos seleccionados fueron analizados según el título, el tipo de estudio, los objetivos del estudio y las conclusiones. Conclusiones: Investigaciones recientes han propuesto un nuevo modelo osteoinmunitario de la osteointegración y una nueva definición de este fenómeno biológico. También se ha propuesto una teoría inmunológica para interpretar las complicaciones biológicas. Esto representa un posible cambio de paradigma en la implantología oral, que permite plantear nuevos enfoques terapéuticos inmunocéntricos para mejorar, mantener y, eventualmente, restaurar la osteointegración. Sin embargo, la evidencia clínica definitiva sigue siendo limitada.
Purpose: The objective of this study is to evaluate the long-term visual and anatomical outcomes of optic nerve sheath fenestration surgery performed through dura-arachnoid window excision in individuals diagnosed with idiopathic intracranial hypertension or cerebral venous sinus thrombosis. Methods: This study retrospectively reviewed records of 46 patients who underwent optic nerve sheath fenestration surgery for idiopathic intracranial hypertension or cerebral venous sinus thrombosis at Uludağ University Ophthalmology Department between September 2001 and January 2012. The data collected from patient records encompassed age, gender, visual acuity, visual field reliability indices, mean deviation indices, intraoperative and postoperative complications, as well as the duration of follow-up. Results: This study encompassed 40 eyes from 26 patients who underwent optic nerve sheath fenestration for papilledema associated with idiopathic intracranial hypertension (IIH) or cerebral venous sinus thrombosis between September 2001 and January 2012. Of the 26 patients (n = 40 eyes), 24 were female and 2 were male. The mean patient age at the time of surgery was 36.2 years, with ages ranging from 23 to 57 years. Twenty-two patients were diagnosed with IIH and four with CVST. The interval between surgery and the final visual field assessment ranged from 36 to 152 months, with a mean duration of 74.4 months. The average postoperative follow-up period was 80.5 months. Conclusion: Patients diagnosed with papilledema and optic neuropathy secondary to idiopathic intracranial hypertension or cerebral venous sinus thrombosis frequently demonstrate improvement in visual function after undergoing optic nerve sheath fenestration utilizing the nerve sheath excision technique.
Infantile appendicitis is a rare condition with atypical clinical manifestations. We present a case of appendicitis in a 43-day-old male infant presenting with acute scrotum and review the literature to identify and analyze similar cases presenting with acute scrotal findings.
El hipoparatiroidismo es una causa poco frecuente de hipocalcemia en niños. Los síntomas iniciales pueden ser inespecíficos, lo que retrasa el diagnóstico. Presentamos el caso de un niño de 12 años con episodios de parpadeo repetitivo interpretados inicialmente como tics funcionales, seguidos de un evento de ahogamiento con sospecha de síndrome de QT largo y, posteriormente, un síncope que reveló hipocalcemia e hiperfosfatemia severas. La revisión retrospectiva mostró anomalías bioquímicas tempranas. La interpretación sistemática de los resultados de laboratorio es crucial para el diagnóstico precoz y la prevención de complicaciones graves.
Objectives: Occupational exposure to chemical agents is a major preventable cause of cancer worldwide. This systematic review synthesized recent epidemiological evidence on the association between occupational chemical exposures and the risk of hematological malignancies, including leukemias, lymphomas, and multiple myeloma, in workers and, secondarily, in their offspring. Methods: A systematic review was conducted in accordance with PRISMA 2020. MEDLINE (via PubMed), EMBASE, and Web of Science were searched for studies published between 2015 and 2025. Observational studies assessing occupational exposure to chemical agents and the incidence of hematological malignancies were included. Data extraction covered study design, population, exposure assessment, cancer subtype, and risk estimates. Methodological quality and risk of bias were assessed using standardized tools, and findings were synthesized qualitatively due to marked heterogeneity. Results: Thirteen studies met the inclusion criteria (5 cohort, 6 case–control, and 2 population-based or ecological). Overall, the evidence indicates consistent associations between occupational exposure to selected chemical agents and increased risks of hematological malignancies, particularly lymphomas and leukemias. The most consistent associations were observed for pesticide exposures, especially organophosphate and carbamate insecticides, often with dose–response patterns. Associations with benzene, organic solvents, and radon were also reported, although with greater heterogeneity. Evidence on formaldehyde and parental occupational exposure was limited and inconclusive. Most studies showed moderate risk of bias, mainly due to exposure misclassification and residual confounding. Conclusions: Occupational exposure to specific chemical agents, particularly certain pesticides, is associated with an increased risk of hematological malignancies. These findings support the prioritization of primary prevention, tighter exposure control, and strengthened occupational health surveillance in high-risk sectors and highlight the need for well-designed prospective studies with refined exposure assessment and detailed subtype analyses.
Los hábitos de salud psicológica constituyen uno de los factores predictores de salud principales dentro de los estilos de vida saludables. Objetivo: Análisis del consumo de alcohol, tabaco y drogas por sexo. Método: Realizamos un diseño descriptivo y transversal sobre una muestra incidental y aleatoria de 788 sujetos adultos de edades comprendidas entre los 22 y 72 años de edad y se aplicó la Escala de Valoración del Estilo de Vida Saludable Adquirido (E-VEVSA), analizando la dimensión que explica los hábitos de salud psicológica. Resultados: Un 17,5% de los sujetos poseen hábitos de salud psicológica poco saludables, un 57,4% hábitos tendentes hacia la salud y tan solo el 25,1% poseen hábitos saludables. Las pruebas de Chi-cuadrado de Pearson muestran una asociación positiva y significativa de los hombres con el nivel tendente hacia la salud, mientras que las mujeres se asocian al nivel poco saludable. Así mismo, con el transcurso de la edad se produce un aumento significativo del nivel del hábito de salud psicológica. Estas diferencias por sexo y edad son corroboradas con las pruebas estadísticas inferenciales (pruebas t-Student y ANOVA de un factor). Conclusiones: Es necesario promover programas preventivos de mejora de la salud psicológica en la población adulta que presenta niveles poco o nada saludables en su estilo de vida.
Introduction: Chronic infection with hepatitis D virus (HDV) represents the most severe form of chronic viral hepatitis and is frequently associated with accelerated liver fibrosis and progression to liver cirrhosis. However, data on HDV prevalence and clinical outcomes among people living with human immunodeficiency virus (PLWH) in Bulgaria remain limited. This observational study aimed to characterize HDV infection and its clinical manifestations among PLWH in southern Bulgaria. Materials and methods: The study was conducted at the Infectious Diseases Clinic of St. George University Hospital, Plovdiv, between April 2024 and December 2025. PLWH aged ≥18 years who tested positive for hepatitis B virus surface antigen (HBsAg) and/or HBV DNA were eligible for inclusion. Serological and molecular markers of hepatitis B virus (HBV), hepatitis C virus (HCV), and HDV were assessed using commercial assays. Clinical data, including liver fibrosis evaluation using the FIB-4 score, HIV viral load, and CD4+ T-cell count, were collected and analyzed. Results: Among 167 PLWH who were screened, 18 (10.8%) met the inclusion criteria for HBV infection: 13 were HBsAg-positive, and 5 had occult HBV infection. Active HDV infection was identified in five patients (38.5% of HBV-infected individuals), including two cases with cirrhosis. No cases of isolated HDV exposure were detected. Viral co-infections were common: four patients presented with triple infection (HCV/HBV/HDV), while one had dual infection (HBV/HDV). Among the triple-infected individuals, three had low HBV DNA levels (<2,000 IU/mL), whereas one initially exhibited high HBV DNA (124,000,000 IU/mL), followed by spontaneous decline during follow-up. All patients were receiving tenofovir-containing antiretroviral therapy. Conclusion: HDV infection among PLWH is associated with aggressive liver disease, including liver cirrhosis, and may influence the replication dynamics of co-infecting viruses. These findings highlight the importance of systematic screening for HDV in individuals infected with HBV, particularly among PLWH. Early detection and careful monitoring may help prevent progression to advanced liver disease, including liver cirrhosis, and improve long-term clinical outcomes.
Background: Cardiometabolic risk is unevenly distributed across populations, following well-established socioeconomic gradients and sex-based differences. However, less is known about how gendered social structures and intersectional social positions shape these inequalities, particularly when different anthropometric and metabolic indices are used to define risk.Objective: To examine the gendered social patterning of cardiometabolic risk within an intersectional framework in a large working population, and to assess whether different indices vary in their ability to capture underlying social inequalities.Methods: A cross-sectional study was conducted among 154,327 working-age adults undergoing routine occupational health assessments. Cardiometabolic risk was defined using multiple anthropometric and metabolic indices, including body mass index (BMI), relative fat mass (RFM), body adiposity index (BAI), a body shape index (ABSI), and METS-VF. Intersectional categories combining sex, educational level, and occupational class were constructed. Multivariable logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs), controlling for age and lifestyle factors.Results: A clear socioeconomic gradient in cardiometabolic risk was observed, with prevalence increasing from 21.4% among individuals with higher education to 36.8% among those with primary or no education. Intersectional analyses revealed substantial heterogeneity, with the highest risk among women in manual occupations with low educational attainment (adjusted OR 2.41, 95% CI 2.28–2.55). Although men showed a higher overall prevalence, relative inequalities were more pronounced among women. The magnitude of associations varied across indices, with stronger gradients observed for measures reflecting visceral adiposity, particularly METS-VF (adjusted OR 1.97). A notable degree of misclassification was identified, as individuals classified as being at low risk by BMI were frequently reclassified as high risk by METS-VF, especially among women.Conclusions: Cardiometabolic risk is strongly patterned by the intersection of gender and socioeconomic position. Inequalities are more pronounced when using indices that capture fat distribution and metabolic dysfunction, whereas reliance on BMI alone may underestimate risk in key population subgroups. Integrating intersectional approaches and more sensitive indices may improve the identification of high-risk individuals and inform more equitable prevention strategies.Keywords: Cardiometabolic diseases. Socioeconomic factors. Gender identity. Obesity. Adiposity. Risk assessment.
Introducción: La caries dental es una de las enfermedades orales más prevalentes a nivel mundial. En los últimos años, la inteligencia artificial (IA), especialmente mediante redes neuronales convolucionales (CNN), se ha propuesto como herramienta para apoyar la detección y mejorar la precisión diagnóstica en odontología. El objetivo de este estudio fue evaluar la precisión diagnóstica de modelos de IA para la detección de caries a partir de imágenes diagnósticas. Métodos: Se realizó una revisión sistemática con síntesis en PubMed, incluyendo artículos publicados entre 2020 y 2025. Se incluyeron estudios en humanos con texto completo disponible que aplicaran IA al diagnóstico de caries y reportaran métricas de precisión diagnóstica. La calidad metodológica se evaluó mediante AMSTAR-2 para revisiones sistemáticas y QUADAS-2 para estudios primarios de precisión diagnóstica. Resultados: Se incluyeron 10 estudios. Las sensibilidades reportadas oscilaron entre 25% y 99,8% (predominando aproximadamente 44%–94%) y las especificidades entre 16,46% y 100% (mayoritariamente 77%–98%). Cinco estudios informaron valores de AUC entre 0,74 y 0,99. Las radiografías aleta de mordida (AMRX) fueron la modalidad más utilizada. Las arquitecturas más frecuentes incluyeron U-Net, ResNet y YOLO. Conclusiones: La IA constituye una herramienta prometedora como complemento al diagnóstico de caries. Sin embargo, la evidencia disponible presenta heterogeneidad metodológica y limitada validación externa, por lo que se requieren protocolos estandarizados, validación multicéntrica y formación profesional para una implementación clínica segura y efectiva.
Objetivos: Presentar el diseño del programa PRISMA, intervención que implementa un circuito estandarizado entre Atención Primaria (AP) y las unidades del sueño para mejorar el cribado y el diagnóstico precoz de la apnea obstructiva del sueño (AOS) en las Islas Baleares. Métodos: PRISMA es un programa de implementación pragmático escalonado, que integra la poligrafía respiratoria (PR) domiciliaria en AP en Baleares. 10 centros de AP en Mallorca fueron equipados con PR. Se cribaron adultos (18-90 años) con sospecha clínica de AOS mediante STOP-Bang y Epworth. Los pacientes con riesgo moderado/alto realizaron PR desde AP. Los resultados se registraron, con derivación hospitalaria en casos confirmados. La implementación incluyó formación, rediseñar flujos de trabajo y retroalimentación estructurada. La evaluación combina indicadores de proceso, de satisfacción y diagnósticos. Resultados esperados: Se espera que PRISMA reduzca retrasos diagnósticos y optimice derivaciones, manteniendo fiabilidad diagnóstica. Un piloto previo mostró buena concordancia entre la PR en AP y la hospitalaria (coeficiente de correlación intraclase ≈0,68), lo que respalda la viabilidad del circuito. Conclusiones: Se detalla un circuito escalable y aplicable en la práctica para el cribado y diagnóstico de AOS en AP, alineado con estándares de las unidades del sueño y evaluable al año.
Objectives: Depressive and anxiety disorders are highly prevalent conditions characterized by recurrent episodes and substantial heritability. From an evolutionary perspective, their persistence poses a longstanding question, given their association with functional impairment. Several explanatory models have been proposed in evolutionary psychiatry, yet no single account fully explains their clinical and epidemiological complexity. This non-systematic review aims to summarize the main evolutionary hypotheses proposed to explain the persistence of depressive and anxiety disorders and to explore the potential contribution of systems-oriented perspectives. Methods: A narrative review of the literature published mainly between 2010 and 2026 was conducted, prioritizing integrative reviews, theoretical models, and representative empirical studies in evolutionary psychiatry, psychiatric genetics, and systems approaches to psychopathology. Results: Proposed explanations include adaptive defense models, evolutionary mismatch, trade-offs and pleiotropy, mutation–selection balance in highly polygenic traits, and pathogen-defense hypotheses. In parallel, recent genetic and network approaches increasingly conceptualize depression and anxiety as emergent properties of complex regulatory systems. Within this context, the schismogenesis hypothesis is discussed as a possible integrative framework describing how reciprocal amplification processes triggered by stress may contribute to reversible biopsychosocial disconnection states. Conclusions: The persistence of depressive and anxiety disorders is most plausibly explained by multicausal models involving evolutionary trade-offs, context dependence, and dynamic regulatory processes. Systems-level perspectives may help integrate existing theories and generate new hypotheses for research and clinical practice.
Objetivo: Conocer los resultados funcionales y la satisfacción de los pacientes tras la cirugía del hallux valgus. Métodos: Estudio descriptivo retrospectivo sobre una población de 123 pacientes con hallux valgus sometidos a intervención quirúrgica. Variables a estudio: edad, género, grado de hallux valgus, presencia de comorbilidades, complicaciones, calidad asistencial, mejora funcional y satisfacción. Para valorar la calidad asistencial y mejora funcional se emplearon las escalas VAS y AOFAS-MI. La satisfacción percibida por los pacientes se evaluó con el cuestionario CSQ-8. El análisis estadístico de los datos se realizó con R y RStudio. Resultados: En nuestra serie, el 82% de los pacientes intervenidos eran mujeres y la edad media en el momento de la cirugía fue de 57 años. El 14,6% presentaba diabetes mellitus, el 31% eran fumadores activos y el 13% seguía tratamiento antiagregante o anticoagulante, configurando una población con comorbilidad relevante. Casi el 60% de los casos correspondía a hallux valgus de grado moderado. La cirugía del hallux valgus se asoció con una clara mejoría clínica y funcional, pasando de valores medios preoperatorios de 7,4 puntos en la escala VAS y 56 puntos en la AOFAS-MI a 1,2 y 91 puntos, respectivamente, en el postoperatorio. La satisfacción fue elevada, con una puntuación media de 28,6 sobre 32 en la CSQ-8 y un 87% de los pacientes dispuestos a repetir el procedimiento. El AOFAS-MI preoperatorio fue el único predictor significativo de la magnitud de la mejoría funcional, mientras que la tasa global de complicaciones alcanzó el 20%, observándose una relación dosis-respuesta entre el número de comorbilidades y la frecuencia de complicaciones. Conclusiones: La cirugía del hallux valgus ofrece resultados funcionales favorables y elevada satisfacción percibida por los pacientes.
Over recent decades, obesity has become firmly established as one of the leading public health problems worldwide, with a steadily increasing prevalence that substantially affects the working-age population. This excess adiposity is associated not only with a higher risk of morbidity and mortality from cardiovascular, metabolic, and musculoskeletal diseases but also with impaired functional capacity among workers, reduced productivity, and diminished long-term participation in the labor market. In the field of occupational health, obesity interacts with organizational, ergonomic, and psychosocial factors, increasing the likelihood of occupational accidents, absenteeism, temporary disability, and early retirement, with a significant impact on both companies and social protection systems. Despite this evidence, obesity remains underrepresented in risk assessment, health surveillance, and preventive policies implemented in workplaces, which continue to focus predominantly on traditional physical, chemical, or biological hazards. This article sets out the positioning of the occupational physician in preventive practice, considering obesity as a key determinant of occupational health. It proposes a comprehensive framework for addressing obesity in the workplace that integrates clinical, preventive, and organizational perspectives, with the aim of informing health policy decisions, guiding corporate strategies, and shaping priority research agendas.
La vacunación es una herramienta preventiva de primer orden en salud pública y salud laboral. Destacan las vacunaciones de la gripe estacional y la vacuna frente a COVID como prioritarias en población general y laboral. Entre los profesionales de los distintos sectores productivos existen diferencias en las tasas de vacunación, destacando una brecha clara entre sectores sanitarios, sociosanitarios y no sanitarios. El ámbito sanitario encabeza las tasas de vacunación, pero se observan desigualdades: médicos y pediatras presentan las tasas más altas, seguidos de enfermería, mientras que el personal auxiliar y de limpieza tiene coberturas notablemente menores, tanto para gripe como para COVID 19. La cobertura vacunal es un indicador clave de salud ocupacional y reclama estrategias específicas, sostenidas y dirigidas a colectivos infravacunados, incluyendo cuidadores formales e informales, para cerrar brechas y reforzar la protección de las personas vulnerables.
