Search Results (132)

Aim: To explore the experiences, beliefs, and values of patients who participated in a two-arm randomized clinical trial assessing a nurse-led intervention program for chronic pain self-management, which demonstrated positive effects on pain reduction, depression, and anxiety, and on health-related quality of life 24 months after completion of the program. Design: Descriptive phenomenological qualitative study. Methods: Patients were recruited via telephone, informed about the study, and invited to participate in an individual interview at a place of their choice (hospital or home). All interviews were audiotaped, and an inductive thematic analysis was performed. Results: Seven interviews were carried out between both groups. Six emerging categories were found: effective relationship with the healthcare system, learning to live with pain, family and social support, behaviors regarding pain, resources for self-management, and concomitant determinants. Conclusions: Patients report key aspects that help us to understand the impact of this type of nurse-led group intervention: the intrinsic therapeutic effect of participating in the program itself, the ability to learn to live with pain, the importance of family and social support, the modification of pain-related behaviors, and the identification of resources for self-care. The findings highlight the need for gender-sensitive, individualized care approaches to chronic pain, addressing stigma and social context. Expanding community-based programs and supporting caregivers is essential, as is further research into gender roles, family dynamics, and work-related factors. Full article

Long-acting (LA) antiretroviral therapies for human immunodeficiency virus (HIV), such as injectable formulations of cabotegravir and rilpivirine (CAB+RPV LA), are now available. Considering the limited data on the out-of-hospital administration of this combination, evaluating the implementation strategies needed is essential to support future clinical efforts. To gather data on barriers and facilitators of implementation for CAB+RPV LA in alternative outpatient facilities, this study used qualitative interviews informed by the Consolidated Framework for Implementation Research (CFIR), with 13 staff participating in the HOLA study (NCT06185452). Data analysis followed qualitative descriptive methods, assisted by Atlas.ti software version 22. The study adhered to the COREQ guidelines. Findings reveal five main factors to consider for implementation: operational and infrastructure adaptations, integrated management of human and organizational resources, need for coordination and follow-up, professional attitudes and work environment, and patient experience and patients’ needs perceived by professionals. This study emphasizes the comprehensive operational and infrastructure adaptations, adequate staff training, and supportive professional environment required for the successful implementation of CAB+RPV LA, while considering patients’ needs throughout the externalization process (trial registration number: NCT06643897). Full article

Background: Myofunctional therapy has emerged as a treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) enables objective measurement of lingual and orofacial muscle strength, although it was originally designed for evaluating dysphagia. OSA is frequently associated with a hypotonic phenotype characterized by reduced strength in upper airway muscles, but its identification remains unclear. Objective: We evaluated the usefulness of IOPI measurements in identifying hypotonic phenotypes among patients with obstructive sleep apnea (OSA). Methods: We carried out a cross-sectional study analyzing the relationship between IOPI scores, sleep polygraphy metrics—such as the apnea–hypopnea index (AHI)—and findings from physical examination. In addition to the standard IOPI protocol, we introduced novel maneuvers aimed at providing a more comprehensive assessment of oropharyngeal muscle function. Results: Although IOPI conventional maneuvers showed no clear association with AHI or ODI, the inferior tongue maneuver showed higher awake tongue strength, with a statistically significant correlation to both AHI (r = 0.2873; p = 0.008) and ODI (r = 0.2495; p = 0.032). Performing each exercise three times yielded highly consistent results across trials (r > 0.94), but did not significantly alter the overall outcome. Interestingly, lower tongue strength values were observed in patients with a high-arched palate (p < 0.05), whereas no relevant associations were found with the presence of a restricted lingual frenulum or CPAP use. Conclusions: Incorporating specific IOPI maneuvers, especially the inferior tongue exercise, may provide additional insight into muscle function in OSA. Selective repetition is advisable for borderline values. Full article

Background/Objectives: This work aims to assess the evolution in the management of Staphylococcus aureus bacteremia (SAB) and the impact of the COVID-19 pandemic on it. SAB is associated with high morbidity and mortality, requiring structured management strategies. The COVID-19 pandemic led to major changes in hospital workflows, potentially affecting the quality of SAB care. Methods: We conducted a retrospective per-protocol analysis of SAB episodes at Costa del Sol University Hospital (Marbella, Spain) across three periods: pre-pandemic, pandemic, and post-pandemic. Patients with early mortality or early transfer were excluded. Clinical variables, adherence to recommended management bundles, and outcomes were compared. Demographic characteristics were similar across the analyzed periods. Results: The incidence of SAB increased over time, with a notable rise post-pandemic. Key management indicators such as the identification of infection source and appropriate antibiotic therapy showed adherence rates of above 90%, while echocardiography exhibited an adherence rate of above 75% throughout the study. Adherence to the full management bundle was suboptimal, with no significant differences between periods. However, an appropriate treatment duration significantly improved in the post-pandemic group (p = 0.038). Mortality at 14 and 30 days was highest during the pandemic period (10.3% and 17.6%, respectively), although differences were not statistically significant. Complications and mortality were more frequent in patients with complete adherence to the bundle (p = 0.031). Conclusions: Despite stable or improved adherence to certain SAB management measures during the pandemic, mortality and complication rates did not significantly decrease, likely reflecting increased patient severity or healthcare system overload. These findings highlight the need for sustained, multidisciplinary, bedside-based approaches to SAB care, even during public health emergencies. Further research is needed to explore modifiable factors and enhance adherence to evidence-based recommendations. Full article

Ankyloglossia causes impairment of normal tongue motility and disrupts the average balance of the muscle forces that form the orofacial complex. Inadequate swallowing from birth can cause long-term anatomical and functional consequences in adult life. Using the video presented herein, we describe the current knowledge about the long-term implications of ankyloglossia. After a literature review of the Medline, Google Scholar, and Embase databases on the relations between ankyloglossia and sleep-disordered breathing, we designed and created a three-dimensional (3D) video using Adobe After Effects based on the anatomical and functional changes produced by repeated deglutition, with and without ankyloglossia, from childhood to adulthood. The animated video (Blender 3D, Amsterdam, The Netherlands, 2024) presented herein was based on the most recent literature review of dentition, breathing, posture, and abnormal swallowing, emphasizing the importance of the potential consequences of sleep-disordered breathing. The resulting animated 3D video includes dynamic sequences of a growing child, demonstrating the anatomy and physiology of deglutition with and without ankyloglossia, and its potential consequences for the surrounding structures during growth due to untreated ankyloglossia. This visual instructional video regarding the impacts of ankyloglossia on deglutition/swallowing may help motivate early childhood diagnosis and treatment of ankyloglossia. This instrument addresses the main myofunctional aspects of normal deglutition based on the importance of free tongue motion and can be used by students or professionals training in myofunctional disorders. Full article

The iCARE Nigeria study is evaluating a daily text message medication reminder intervention (TXTXT) to improve viral suppression and medication adherence among youth living with HIV (YLH), aged 15–24 years. In this sub-study, we evaluated text message responsiveness (text-back) at 24 weeks of the intervention as an indicator of engagement, as well as barriers and facilitators at one of six clinical study sites. Differences in responses by age group, birth sex, schooling status, education, mode of infection, and weekend/weekday and holiday/non-holiday periods were analyzed using t-test and multiple linear regression. Focus group discussions were conducted among three groups (low, average, and high text message responsiveness) and analyzed using a rapid content analysis approach. Overall, TXTXT responsiveness was 26.5% (4606/17,367); older age (18–24 years) and weekdays (versus weekends) were significantly associated with higher responsiveness. Facilitators included being comfortable receiving personalized text messages. Barriers included a lack of airtime and messages received late. Overall, text-back responsiveness to daily medication adherence messages among YLH was low, better among older participants, and higher on weekdays. Addressing barriers and promoting facilitators may improve responsiveness. Full article

Background and Objectives: Wound management in complex and traumatic injuries remains a significant clinical challenge, with a high risk of surgical site infections (SSIs) and associated complications. This systematic review and meta-analysis aim to evaluate the effectiveness of diverse interventions, including Negative Pressure Wound Therapy (NPWT), advanced dressings, irrigation techniques, antibiotic regimens, and innovative therapies, in improving wound healing outcomes and reducing infection rates. Materials and Methods: An exhaustive literature search focused on the use of NPWT, dressings, and antibiotics in the care of chronic wounds was conducted following PRISMA guidelines in the PubMed, Scopus, Web of Science, and CINAHL databases. Eligible studies included randomized controlled trials and prospective cohorts assessing interventions for wound care in trauma, surgical, and chronic wound settings. The risk of bias was assessed using the ROB2 tool. Subgroup analyses were performed to evaluate the relative risk (RR) of infections based on the intervention type. Results: The analysis included 17 studies spanning diverse geographical and clinical settings. NPWT demonstrated significant benefits in reducing infection rates compared to control groups (RR: 0.590, 95% CI: 0.458–0.760, and p < 0.001). Although advanced dressings demonstrated clinically relevant benefits as reported across the included studies, the meta-analysis did not reveal statistically significant differences (RR: 0.516, 95% CI: 0.242–1.100, and p = 0.087). Antibiotic therapies significantly reduced infections when administered within 24 h of injury, while low-pressure irrigation techniques effectively minimized bacterial contamination without causing tissue damage. Growth factors and honey-based treatments exhibited promising results in accelerating wound healing and reducing infection risks in chronic wounds. Conclusions: NPWT emerges as a highly effective intervention for infection prevention and wound healing, supported by robust evidence. Advanced dressings and innovative therapies show potential but require further research for conclusive evidence. These findings underscore the importance of tailoring wound care strategies to the clinical context and patient needs. Future research should focus on long-term outcomes and cost-effectiveness analyses to enhance the integration of these therapies into clinical practice. Full article

Background: Mild cognitive impairment (MCI) represents an early stage of cognitive loss that significantly increases the risk of dementia. The aim of this study was to comprehensively synthesize the current evidence on the effect of combined physical and cognitive therapies in older adults with MCI. Methods: A systematic review with meta-analysis was conducted by searching for specific keywords in the PubMed, Scopus, Cinhal, and Web of Science databases. This meta-analysis included a total of 2256 participants distributed across 21 studies that evaluated the benefits of combining physical exercise with cognitive stimulation. Results: This review revealed that these types of therapies present a significant improvement in memory, attention, and executive functions. Participants showed notable improvements in these cognitive areas, highlighting the synergistic effects of physical exercise and cognitive stimulation, which exceeded the benefits of each therapy separately. These results contribute to the understanding of how these combined therapies can improve cognitive health in this population, offering robust evidence supporting their application in clinical practice. Conclusions: This meta-analysis shows that combined physical exercise and cognitive stimulation interventions may be an effective strategy for improving cognitive health in older adults with MCI. The findings of this study offer a valuable contribution to the field, highlighting the potential of these combined therapies to prevent cognitive decline and improve the quality of life of this population. The results may be of interest to health professionals and guide future research and clinical applications. Full article

COVID-19 has been a challenge at the healthcare level not only in the early stages of the pandemic, but also in the subsequent appearance of long-term COVID-19. Several investigations have attempted to identify proteomic biomarkers in an attempt to improve clinical care, guide treatment and predict possible patient outcomes. Proteins such as C-reactive protein (CRP) or interleukin 6 (IL-6) are clear markers of severe disease, but many others have been proposed that could help in risk stratification and in the prediction of specific complications. This review aims to bring together the most relevant studies in this regard, providing information to identify the most notable biomarkers in relation to COVID-19 found to date. Full article

Background: Male patients with congenital hypogonadotropic hypogonadism (CHH) have impaired postnatal activation of the hypothalamic–pituitary–gonadal axis that occurs during mini-puberty. The aim of this study was to report our experience using gonadotropin replacement therapy for mini-puberty in male infants with CHH and to establish treatment recommendations. Methods: The patients included in this retrospective case series (n = 9) were diagnosed in the postnatal period due to micropenis, with two being accompanied by cryptorchidism and four with other associated hormonal deficits. All patients started treatment with gonadotropins early after diagnosis, between 2 weeks and 5 months of age, with a schedule of discontinuous injections with subcutaneous human chorionic gonadotropin (62.5–500 IU) two times per week and recombinant follicle-stimulating hormone-alpha (37.5–75 IU) three times per week. Results: The data from our study show an early response, ranging from almost undetectable levels of testosterone at diagnosis to elevated levels after starting treatment, as well as a positive clinical response with increases in testicular volume and penis size in all cases without requiring complementary treatment with testosterone esters and without adverse effects. Conclusions: Our results show that gonadotropin replacement therapy is a well-tolerated and effective treatment for testicular and penile problems in male patients with CHH. Full article

Cigarette butts (CBs) are a major source of persistent pollution in coastal ecosystems, introducing harmful chemicals and microplastics into the environment. This study assesses the ecotoxicological impact of CB leachates on Marbella Beach, Chile, by analyzing the metal contamination and its phytotoxic effects on Lactuca sativa and Lolium perenne. Three scenarios were evaluated: CBs alone, CBs mixed with sand, and sand alone. Leachate analysis revealed significant concentrations of iron and zinc, with higher toxicity observed in scenarios involving CBs. Ecotoxicological assays demonstrated that cigarette butt leachates severely inhibited seed germination and plant growth, particularly in Lactuca sativa, which showed greater sensitivity compared to that of Lolium perenne. The results underscore the partial mitigating role of sand, although it was insufficient to prevent the toxic effects of CBs. The persistence of cellulose acetate in the environment and the continued release of hazardous chemicals highlight the ecological risks posed by cigarette butt pollution. These findings emphasize the need for improved waste management strategies and the development of biodegradable cigarette filters to reduce environmental contamination in coastal areas. Full article

Tonsillectomy is considered the standard of care in patients with obstructive sleep apnea (OSA) and large tonsils; however, there are selected cases where this procedure should not be considered. We present two patients with tonsil grade 4 and severe OSA where tonsillectomy was not the solution for their problem and could be a superfluous procedure. In our experience, a preoperatory drug-induced sleep endoscopy (DISE) and proper patient phenotyping will prevent this type of surgical failure. Full article

Social media plays a crucial role in health information dissemination, yet it also raises concerns about misinformation. This study examines the role of Spanish health centers in promoting influenza vaccination on social networks, particularly X (formerly Twitter), during the 2023–2024 campaign. An observational, retrospective study analyzed the activity of 832 Spanish health centers on X. Data collection focused on the existence of official accounts, follower engagement and the nature of messages posted. Metrics were obtained using X Analytics, and statistical analysis was performed using JAMOVI v2.4 software. Of the 832 centers, 607 had readable X accounts. Collective accounts were more prevalent (351) than individual ones (239). Collective accounts had significantly more followers and posts but showed less engagement compared to individual accounts. The most followed accounts belonged to public entities, like the Community of Madrid and private organizations, such as Sanitas. An analysis of the vaccination campaign revealed that most posts had a political focus with limited health information, resulting in minimal interaction with the public. As a conclusion, the study highlights the fragmented nature of health communication through social networks in Spain. Despite the higher visibility of collective accounts, their engagement with the public is low, often due to the political nature of posts. A unified national strategy is essential for enhancing public health communication, focusing on interactive and relevant content. Full article

This work aims to assess the impact of the COVID-19 pandemic on the mortality and incidence of complications in patients with bacteraemia due to Staphylococcus aureus (BSA). All episodes of BSA at the Costa del Sol University Hospital (Marbella, Spain) were recorded during the acute phase of the COVID-19 pandemic (March 2020–March 2022) and compared with those in a previous period (February 2018–February 2020). Demographic, clinical and prognostic variables were recorded. The outcomes were measured as 14- and 30-day mortality and the incidence of complications/death. Mortality during the pandemic was 28.7% at 14 days and 35% at 30 days, while in the pre-pandemic group, it was 18.9% and 23.3%, respectively. For overall complications/deaths, the incidence rate was higher in the pandemic group, with 42.7%. No significant differences were observed between groups. Seventeen patients with COVID-19 were identified, with mortality rates of 64.7% and 70.6% at 14 and 30 days. Multivariate analysis established the presence of sepsis at diagnosis as a predictor of mortality, but not BSA, during the pandemic phase. In conclusion, BSA is a disease with high mortality, which was slightly higher during the pandemic phase. No differences were found in adherence to the bundle in our centre. Full article

Real-world evidence on the impact of monoclonal antibodies as first-line treatment in Spain is limited. This observational, retrospective and prospective, multicenter, descriptive study included 117 transplant-ineligible newly diagnosed multiple myeloma (TIE-NDMM) patients divided into Group A, who received no daratumumab standard regimens, and the DVMP group (daratumumab, bortezomib, melphalan, and prednisone treatment). More than 90% of the patients in Group A received bortezomib, lenalidomide, or a combination of them. The median follow-up time for Group A was 38.2 months in comparison to 25.8 months for the DVMP group (p < 0.0001). The rate of DVMP patients that experienced disease progression or death from any cause was 36.8%, compared to 67.3% of Group A patients at 36 months of follow-up. The DVMP group had a higher 36-month progression-free survival (PFS) rate (52.9% vs. 31.7%). During the retrospective period, 73.0% of patients reported adverse drug reactions, while in the prospective period, 40.5% experienced adverse events, with no clinical differences between groups. The study supports the use of daratumumab regimens in frontline therapy based on real-world data. The findings provide valuable insights into the clinical outcomes of daratumumab therapy, which can help physicians make informed decisions regarding the optimal treatment approach for this patient population. Full article