Antimicrobial resistance (AMR) is a global health challenge. Clinical trials are essential for evaluating novel and alternative therapeutic strategies. However, conducting randomized clinical trials (RCTs) in infectious diseases faces regulatory, logistical, and financial barriers, as well as challenges in patient recruitment. Collaborative research networks have demonstrated their effectiveness in overcoming these limitations. This study evaluates the capacity of Spanish medical centers to participate in RCTs on infectious diseases and AMR. A structured feasibility survey was developed to assess infrastructure, research experience, patient recruitment potential, and willingness to collaborate in Spanish hospitals. Responses were collected using the REDCap platform and analyzed using Microsoft Excel, with results expressed as percentages. Of 90 centers contacted, 65 centers from 17 autonomous communities responded. The majority (78.5%) had dedicated infectious disease departments or units, and 36.9% reported over 1000 annual hospital admissions for infectious diseases. Research experience was strongest in antimicrobial-resistant Gram-negative (84.6%) and Gram-positive bacteria (78.5%). Phase II-IV RCTs were the most conducted trials, predominantly funded by private sources. While 75.4% of centers reported available human resources for research, specialized roles such as project managers (18.5%) and monitors (12.3%) were less common. Notably, 90% of centers expressed willingness to participate in a collaborative network for conducting unfunded RCTs. The results highlight Spain's strong research infrastructure and expertise in infectious diseases, providing a solid foundation for establishing a national collaborative clinical trials network. However, variations in specialized research personnel and the low frequency of academic trials indicate areas for improvement.
Quantitative hepatitis B surface antigen (qHBsAg) is increasingly recognized as a key biomarker for chronic hepatitis B (CHB) management. This study aimed to assess the adoption, practices, and barriers to qHBsAg testing in Spanish clinical microbiology laboratories. A cross-sectional survey was distributed through the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) Viral Hepatitis Study Group (GEHEP). Clinical microbiology laboratory professionals across Spain were invited to complete an anonymous online questionnaire. The survey collected information on qHBsAg implementation, technical practices, barriers, and patient-related data. Descriptive statistics were applied. Of 118 laboratories invited, 91 responded (77.1%); only 37.4% performed qHBsAg. Among non-performing centers, 86% did not refer samples, mainly due to perceived low clinical demand (57.1%), plus lack of equipment/resources. Implementation correlated with hospital size (p=0.041): 0% (<200 beds), 23.3% (200-500), 44.9% (500-1000), 62.5% (≥1000). Among performing labs, 57.6% quantified after a positive qualitative test, 27.3% on request, and 15.2% as initial screening. Proactive reporting was 69.7%, and 81.8% diluted samples above limits. In the last year, 40.7% of results were <100IU/mL and 27.1% >3000IU/mL; over five years (≈14,500 tests), 29.5% >3000IU/mL and 27.3% <100IU/mL, supporting the clinical relevance of these thresholds. qHBsAg testing is not uniformly implemented across Spanish clinical microbiology laboratories and workflows and reporting practices are heterogeneous. Given the descriptive design and potential selection bias, these results should be interpreted as a baseline assessment to inform harmonization efforts and future evaluations linking testing availability to clinical decision-making.
Background Social support is an important psychosocial resource that can facilitate engaging in healthy behaviors, including oral health behaviors. Nine scales assessing Oral Health Behavior Social Support (OHBSS) for brushing, flossing and seeking dental care were developed and validated in the English and Spanish languages. The full-length scales included 37 required items to assess social support from three sources: family, health providers, and others/friends. The OHBSS-SF scales cover three oral health behaviors, use six items each to assess social support for brushing, flossing and dental care, and retain the nine-scale structure. Response options range from one (never) to four (always), with higher scores reflecting more frequent receipt of social support. This paper describes the item reduction process/outcomes and presents model fit indices and psychometric properties of the 17-item OHBSS-Short Form (OHBSS-SF) scales. Methods A large Mexican-American young adult sample completed an online survey in English or Spanish (N = 502). Participants completed the OHBSS-SF along with several other validated scales assessing general social support, dental fear, and acculturation. The survey also queried oral health behaviors of interest and socio-demographic characteristics. A subset of participants (n = 56) also completed the OHBSS-SF items a second time two to six weeks later to assess test-retest reliability. Model fit indices and psychometric properties for each of the nine OHBSS-SF scales were calculated for the full sample and subgroups stratified by the three study design characteristics of language (English/Spanish), sex (male/female), and marital status (single/married). Results The OHBSS-SF scales correlated very highly with the full-length versions (r = 0.95-0.98), and all OHBSS-SF scales exhibited acceptable model fit indices. The OHBSS-SF demonstrated stability in the full sample and in Spanish, with good to excellent intra-class correlations, supporting test-retest reliability. Patterns of moderate correlations supported convergent validity with validated general social support measures. Patterns of weak correlations suggested divergent validity between OHBSS-SF and other non-social support measures. Conclusions The OHBSS-SF demonstrated acceptable psychometric properties. A few significant differences by subgroup characteristics were identified. The OHBSS-SF scales reduce respondent burden and are a useful tool to ascertain frequency of receipt of oral health behavior social support from family, health providers, and other/friend sources.
Cannabis is the most commonly used illicit substance during pregnancy. Negative health and social outcomes associated with cannabis use disproportionately affect birthing people of color, particularly Latinas. Latina birthing people face compounding barriers to prenatal care, including discrimination, immigration-related fears, and distrust of healthcare systems rooted in histories of obstetric racism. This study examines the perspectives and experiences of Latina birthing people in California as they navigate prenatal care while using cannabis. We conducted qualitative, semi-structured interviews with 20 Latina birthing people. Eligible participants reported current or previous pregnancy within the last year concurrent with cannabis use, identified as Latina, lived in California, were 21 years or older, and spoke English and/or Spanish. We used constructivist grounded theory methods to analyze the data. We found that Latina birthing people who use cannabis: 1) Perceived their intersectional identities (race/ethnicity, age, partnership status) as potential vulnerabilities to poor prenatal care, particularly around cannabis use disclosure; 2) Sought more supportive clinicians based on these intersectional identities, though financial and insurance barriers prevented them from accessing preferred clinicians; and 3) Proposed solutions to improve their care, such as identifying clinicians who looked like them or adopting a whole-person approach that contextualized their cannabis use within their lived experiences. Discrimination, stigma, and racial profiling of Latina birthing people who use cannabis contribute to unsafe prenatal care environments. Open communication about the motivations and implications of cannabis use is needed to improve prenatal experiences and outcomes for Latinas, who may be using cannabis as a form of self-medication in the context of inadequate care access. Given that Latina birthing people who use cannabis experience discrimination, stigma, and racial profiling in prenatal care settings, it is critical to build structurally competent clinical environments that foster open, nonjudgmental counseling where discussions around cannabis use can occur safely. Systems-level interventions are needed, including clinician training on cannabis use counseling and bias, expanded and diversified clinical workforces, and community-based care options, such as doula integration.
Malocclusion in mixed dentition is highly prevalent, and this phase has specific characteristics that hinder its epidemiological assessment and the standardization of diagnostic criteria. To map the criteria used to assess malocclusion in mixed dentition in epidemiological studies, identify reported results, and point out existing methodological gaps. In 2025, an exploratory review was conducted in accordance with the recommendations of the Joanna Briggs Institute and the PRISMA-ScR checklist. The guiding question was constructed based on the PCC (Population: children; Concept: criteria for assessing malocclusion; Context: mixed dentition). Searches were conducted in PubMed, MEDLINE, Scopus, Embase, Web of Science, and LILACS databases, as well as pre-registration platforms and grey literature. Primary studies in English, Portuguese, or Spanish were included without year restrictions. A total of 3,210 studies were identified, of which 58 met the inclusion criteria. There was considerable heterogeneity in the criteria used, with a predominance of indices originally developed for permanent dentition, such as the Dental Aesthetic Index (DAI) in 13 studies and the Index of Orthodontic Treatment Need (IOTN) in 18 studies. The absence of a standardized and widely validated approach for assessing malocclusion in mixed dentition compromises data comparability and may limit diagnostic accuracy in epidemiological studies. Although several assessment methods have been proposed, further studies are needed to determine whether adapting existing indices or developing new assessment tools would provide a more appropriate approach for this developmental stage.
Genetic testing (GT) is established in ambulatory cardiomyopathy (CM), but its utility after heart transplantation (HTx) recipients remains poorly characterized. This study aimed to evaluate the clinical utility of GT in adult HTx recipients with CM, focusing on etiologic reclassification, family cascade screening, and the genetic architecture of end-stage disease. GenbaseHTx is a nationwide, multicenter retrospective study of adult HTx recipients transplanted for CM across 12 Spanish centers (2010-2023). GT results were centrally adjudicated using American College of Medical Genetics and Genomics criteria. Outcomes included prevalence of pathogenic/likely pathogenic variants, etiologic reclassification after GT, and cascade screening activation. Among 657 HTx recipients, a pathogenic/likely pathogenic variant was identified in 53% (351/657). GT led to etiologic reclassification in 35% (231/657) (42% when performed post-HTx -106/253-). Family screening (performed in 69% of families -224/328-) identified affected relatives in 22% (19/90) of genotype-negative and 42% (49/107) of genotype-positive cases. Notably, a genetic etiology was identified in 36% (15/42) of CM initially attributed to acquired or "second-hit" causes. In dilated cardiomyopathy, the genetic architecture of transplanted patients differed from ambulatory cohorts, with lower TTN variant prevalence and enrichment of arrhythmogenic genes. GT remains clinically actionable after HTx, enabling etiologic reclassification and driving cascade screening. These findings support systematic GT in HTx recipients with CM, including those with prior environmental triggers or second-hit etiologies, and regardless of time from transplantation.
Prospective cohort studies analyzing the effect of plant versus animal protein intake on mortality in relatively young individuals from Mediterranean populations are limited. Moreover, a limited number of studies have performed repeated measurements of protein intake. We evaluated the relationship between plant versus animal protein intake (at baseline and at the ten-year follow-up) and mortality in the "Seguimiento Universidad de Navarra" (SUN) project. The SUN project is a prospective, multi-purpose, dynamic cohort study of Spanish university graduates. Plant and animal protein intake were assessed using a semi-quantitative food frequency questionnaire (FFQ) previously validated in Spain. Participants were divided into quartiles based on their intake of protein. Cox regression models were used, with the first quartile serving as the reference category. A total of 17,989 subjects (10,961 women and 7028 men) were included in the analysis. During 251.363 person-years of follow-up (median follow-up time: 12 years), 460 deaths were identified. The mean age at baseline was 38 years with a standard deviation of 12 years. Participants in the highest quartile of plant protein intake had a 35% lower risk of all-cause mortality compared to those in the lowest quartile after adjusting for potential confounders [hazard ratio (HR): 0.65 (95% CI: 0.45-0.93), p for trend = 0.009]. No significant association was found between animal protein intake and mortality [HR: 0.94 (95% CI: 0.70-1.26); p for trend = 0.555] nor between plant protein intake and cardiovascular or cancer mortality. Plant protein intake was inversely associated with all-cause mortality in a Mediterranean population. Animal protein intake was not associated with total mortality.
Estimar la prevalencia de consumo actual de cannabis en población mexicana de 12 a 65 años, así como la prevalencia de problemas físicos y emocionales, propios o a terceros. Material y métodos. Análisis de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco (Encodat) 2025. Se estimaron prevalencias de consumo en el último mes, la frecuencia de consumo como indicador de intensidad y problemas asociados. La prevalencia de consumo actual fue 1.4% (1.3 millones). Entre consumidores actuales, 49.2% reportó consumo semanal o diario, y 26.6% reportó problemas físicos o emocionales asociados. Actualmente, más de 1.3 millones de personas en México, consumen cannabis con alta intensidad y presentan problemas asociados. Pese a la baja prevalencia, es importante establecer vigilancia y prevención enfocados en el consumo frecuente.
Evidence on specialist palliative care and advance care planning (ACP) for kidney transplant recipients (KTRs) near the end-of-life remains limited. We conducted a single-center retrospective observational study (electronic health record chart review) at a tertiary transplant center in Madrid, Spain. We included adult KTRs who died between January 1, 2021, and December 31, 2023, with sufficient end-of-life documentation; SARS-CoV-2-related deaths and deaths outside health care settings or with insufficient records were excluded. We compared end-of-life outcomes by specialist palliative care (PC) involvement and by ACP category. Outcomes included documented symptoms within 5 days before death, documented moderate-to-severe suffering within 48 hours (based on narrative chart descriptors), documented intent to prioritize symptom control in the last 24 hours, aggressive treatments within 7 days (intensive care unit/intermediate respiratory care unit admission, surgery/percutaneous intervention, renal replacement therapy, and/or intensive in-hospital management), place of death, and documented family positive perception of end-of-life care. Fifty-nine deceased KTRs were analyzed; 20 (33.9%) received PC, and 39 (66.1%) did not. Compared with no PC, PC involvement was associated with a lower prevalence of documented symptoms within 5 days before death (5/20 [25.0%] vs. 38/39 [97.4%]; p < 0.001), documented moderate-to-severe suffering within 48 hours (0/20 [0%] vs. 36/39 [92.3%]; p < 0.001), and a higher documented intent to prioritize symptom control in the last 24 hours (20/20 [100%] vs. 22/39 [56.4%]; p < 0.001). PC involvement was also associated with fewer deaths in high-acuity settings and more home or hospice deaths (p < 0.001). Across ACP categories, comprehensive ACP was associated with fewer documented symptoms within 5 days (1/9 [11.1%] vs. 18/18 [100%] with no ACP; p < 0.001) and no documented moderate-to-severe suffering within 48 hours (0/9 [0%] vs. 18/18 [100%] with no ACP; p < 0.001). In this single-center retrospective study, PC involvement and more comprehensive ACP were associated with more favorable end-of-life outcomes among KTRs. Prospective studies are needed to confirm these associations.
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Documentar la conformación de la Red Mexicana de Investigación sobre Actividad Física, Sueño y Sedentarismo (REMIASS) y reportar acciones prioritarias en México para frenar y revertir la crisis de inactividad física y comportamientos sedentarios en México. Material y métodos. Se realizó un mapeo y una convocatoria de la comunidad académica y científica en México. Mediante el método Delphi modificado se desarrolló una encuesta en línea para buscar consenso (>80%) para identificar acciones prioritarias analizadas mediante estadísticas descriptivas. Las acciones prioritarias recomendadas por REMIASS fueron mejorar los índices de criminalidad y la apropiación del espacio público; incrementar la seguridad de peatones y ciclistas; desarrollar e implementar una Estrategia Nacional de Promoción de la Actividad Física; fortalecer la capacitación en actividad física, comportamiento sedentario y sueño; y promover una educación física de calidad. Este esfuerzo suma a las acciones para atender la salud humana y planetaria.
Caracterizar a los usuarios de videojuegos en México, estimar la frecuencia del trastorno de juego por internet (IGD, por sus siglas en inglés), describir su sintomatología y evaluar la escala IGDS9-SF, así como analizar su asociación con condiciones de salud mental. Material y métodos. La Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2025 es una encuesta nacional, representativa de la población de 12 a 65 años realizada mediante entrevistas cara a cara. Considerando el diseño complejo de la encuesta, se estimaron prevalencias de uso de videojuegos, de los nueve síntomas de IGD, y de IGD. Se aplicó teoría de respuesta al ítem para estudiar las características psicométricas. Las asociaciones se expresaron como razones de prevalencias ajustadas mediante modelos lineales generalizados. El 23.2% de la población usa videojuegos. Entre ellos, 14.4% reportó al menos un síntoma de IGD y 0.9% (IC95%: 0.6,1.3) fue positivo a IGD, equivalente a 0.2% en la población general. La escala IGDS9-SF mostró unidimensionalidad y ajuste excelente (n= 4 554; CFI/TLI >0.95; RMSEA <0.06). El IGD se asoció con malestar psicológico (RPa= 3.48; IC95%: 2.12,5.70), conductas suicidas y uso de drogas. Conclusión. Aunque el IGD es infrecuente en la población general, se asocia con importantes problemas de salud mental. La escala IGDS9-SF podría ser adecuada para el contexto mexicano.
Evaluar si el impuesto a las bebidas azucaradas implementado en México en 2014 estuvo asociado con un aumento en el consumo de cerveza. Material y métodos. Se estimó un análisis de series de tiempo interrumpidas para analizar los cambios en las ventas domésticas per cápita de cerveza asociados con el impuesto a las bebidas azucaradas. Se realizó una prueba de falsificación mediante el desplazamiento del periodo de implementación del impuesto para verificar si los cambios en las ventas nacionales per cápita de cerveza estaban relacionados con la implementación del impuesto. Se encontró un aumento en la tendencia mensual de ventas per cápita de cerveza de 0.03 litros (IC95%: 0.02,0.04; p= 0.00) en el periodo posterior al impuesto. Conclusión. El aumento en las ventas nacionales per cápita de cerveza asociados con el impuesto a bebidas azucaradas fue muy bajo, de menos de 1%, sin embargo, es importante diseñar políticas fiscales que eviten sustituciones por productos no gravados.
Caracterizar la exposición a publicidad de productos de tabaco y nicotina (PPTN) y su asociación con conocimiento, susceptibilidad y consumo en adolescentes y adultos mexicanos. Material y métodos. Estudio transversal de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2025 (Encodat). Se analizaron 3 803 adolescentes y 14 905 adultos. Se estimaron las razones de prevalencia y las razones relativas de riesgo mediante modelos de Poisson y de regresión logística multinomial. La exposición a PPTN fue elevada, especialmente en puntos de venta (32.4%) e internet (26.2%); además, se asoció con un mayor conocimiento sobre los productos de nicotina en ambos grupos. En adolescentes, se vinculó con la susceptibilidad de fumar y con un mayor consumo de cigarros electrónicos y combustibles. Pese a las prohibiciones, la exposición a PPTN persiste y se asocia con desenlaces adversos, lo que enfatiza la necesidad de reforzar las medidas regulatorias.
Evaluar la calidad de los registros de defunciones en México entre 2000 y 2023, comparando los periodos antes, durante y después del Covid-19, con el fin de identificar áreas de oportunidad a la calidad de la información. Material y métodos. Estudio descriptivo de series temporales basado en los registros de mortalidad del Instituto Nacional de Estadística y Geografía (Inegi) a nivel nacional y estatal. La calidad de la información se evaluó mediante el Índice de Calidad de la Información (ICI) de la Secretaría de Salud. Se analizaron tres periodos: pre-Covid-19 (2000-2019), durante-Covid-19 (2020-2022) y pos-Covid-19 (2023). El ICI nacional se mantuvo entre 95.1 y 101.4% durante todo el periodo. El índice aumentó de 96.6% en 2019 a 101.4% en 2020 y 2021, y disminuyó a 98.8 % en 2022. El promedio del ICI fue de 96.4% en pre-Covid-19, 99.8 % durante-Covid-19 y 98.3 pos-Covid-19. Las entidades con mayor cobertura fueron Ciudad de México, Chihuahua y Baja California; las más bajas Guerrero, Campeche y Estado de México. La cobertura estatal promedio fue mayor durante-Covid-19 (108.6%) que pre-Covid-19 (96.5%) y pos-Covid-19 (95.9%). Conclusión. La calidad de los registros de defunciones en México se mantuvo por encima de 95% entre 2000 y 2023. La pandemia por Covid-19 no afectó negativamente la calidad de la información una vez ajustado el exceso de mortalidad; no obstante, se observó una disminución posterior que requiere monitoreo y fortalecimiento de los sistemas de información en salud.
Analizar la tendencia de la prevalencia de infecciones respiratorias agudas (IRA) en niñas y niños (NN) menores de cinco años en México entre 2006 y 2021-2024. Para 2021-2024, estimar la distribución por región y entidad federativa, describir características sociodemográficas y del episodio, e identificar factores asociados con su ocurrencia estratificado por urbanidad. Material y métodos. Se utilizaron datos de Ensanut 2006, 2012, 2018 y Ensanut Continua 2021-2024. Para 2021-2024 se incluyeron 8 100 observaciones que representan a 10 115 501 NN. Se estimaron prevalencias y se ajustaron modelos de regresión logística (cruda y ajustada) para identificar factores asociados. La prevalencia nacional de IRA disminuyó de 48.1% (2006) a 20.4% (2021-2024; p-trend <0.001). En el periodo 2021-2024 se observó gradiente por urbanidad: metropolitano 18.7%, urbano 20.5% y rural 22.9%. Las mayores prevalencias se concentraron en Península (29.8%) y Pacífico-Sur (23.3%). Factores asociados con mayor probabilidad de IRA incluyeron bajo nivel de bienestar, residencia en regiones específicas y, en zonas rurales, menor escolaridad materna. Conclusión. Aunque la prevalencia de IRA disminuyó significativamente, en 2021-2024 persisten diferencias por urbanidad (mayor en contextos menos urbanizados) y desigualdades regionales y socioeconómicas. Es necesario fortalecer intervenciones diferenciadas y asegurar la equidad en el acceso a servicios de salud, abordando los determinantes sociales que sostienen estas brechas.
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The origin of magnetic switchbacks-large-amplitude, spherically polarized magnetic-field fluctuations with local polarity inversions shown to be nearly ubiquitous in the inner heliosphere by Parker Solar Probe-is presently one of the most outstanding open questions in solar and heliospheric science. The occurrence of these structures in the young solar wind is a topic of active research, focusing not only on their characteristics and evolution but also on unraveling the puzzle of their origin. We first discuss the potential influence on switchback (SB) formation of large-scale coronal dynamics and restructuring processes that shape and regulate the extended solar corona. Following that, we review the dynamics, physical properties, occurrence rate, and energetics of numerous possible precursor small-scale dynamic events that occur throughout the solar atmosphere, emphasizing their possible roles in creating SBs. Finally, we discuss some recent studies attempting to connect in situ observations of SBs and SB patches with remote-sensing observations, and the related challenges in identifying solar wind source regions precisely and linking in situ observations to transient solar phenomena. We also clarify the terminology used by the solar community to describe small-scale solar phenomena.
Desarrollar un modelo de pronóstico base para los casos de dengue. Material y métodos. Se analizó una serie temporal de 2000-2024, utilizando datos de fuentes oficiales y se evaluó el rendimiento predictivo con modelos autorregresivos integrados de promedio móvil estacional (SARIMA). Se identificaron patrones estacionales críticos con picos de incidencia en los últimos meses del año. El modelo SARIMA base seleccionado explicó 75% de la variación observada. Las proyecciones para 2025-2027 predicen una alta incidencia continua. Notablemente, la inclusión de variables climáticas exógenas, precipitación y temperatura no mejoró significativamente el poder predictivo del modelo. Conclusión. El estudio concluye que el dengue se ha consolidado como una enfermedad endémica en la región. El modelo base propuesto es una herramienta para continuar fortaleciendo las intervenciones sanitarias proactivas.
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