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In patients with a hip fracture, anaemia has been associated with increased transfusion requirements, poor functional outcomes, prolonged hospital stays and increased mortality. While anaemia in elderly patients with hip fractures has traditionally been attributed to bleeding during or after surgery, many of these patients are anaemic on hospital admission. Thus, detecting and managing anaemia in the perioperative, postoperative and, most significantly, the preoperative period is important to avoid the need for blood transfusions and to improve patient outcomes. The protocol for this clinical trial is designed to evaluate the efficacy and safety of both combined intravenous and topical tranexamic acid (TXA) therapy, or topical administration alone, assessing its effect on blood loss and the need for blood transfusions in elderly patients undergoing hip fracture surgery. This is a multicentre, double-blinded, randomised, placebo-controlled trial with a 1:1 allocation ratio. Patients of both sexes, aged ≥65 years, who are admitted to the emergency department and will undergo hip fracture surgery are eligible for enrolment. Eligible patients who provide their consent will be stratified according to the type of fracture (intracapsular and extracapsular) and whether or not they are suitable for intravenous TXA therapy, and they will then be randomly allocated to receive either TXA or a placebo. The primary outcome is the blood transfusion rate from patient admission to the emergency department until discharge, while the secondary outcomes include: the preoperative, perioperative and postoperative haemoglobin and haematocrit levels; the preoperative and postoperative occult and total blood loss; the mean length of hospital stay; and any adverse events assessed for up to 1 year after patient discharge. The study was approved by the Basque Country Ethics Committee (Ref.: 2021012) and the Spanish Agency for Medicines and Healthcare Products (Agencia Española de Medicamentos y Productos Sanitarios). All participants will provide their written informed consent prior to study inclusion. The trial's results, regardless of its outcomes, will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals, and they will be made publicly available through the European Union Clinical Trials Register after the end of the clinical trial. EudraCT Number 2020-002144-23; EUCT Number 2024-519349-31-00.

Italy currently ranks among the world's oldest nations, with adults aged ≥65 years accounting for 24.1% of the population - the highest proportion in the EU - and a projected median age of 51 years by 2050. While life expectancy at birth reaches 85.4 years for women and 81.4 for men, Healthy Life Years amount to only 69.6 and 68.5, respectively, documenting a substantial lifespan-healthspan divide. The prevalence of multimorbidity and disability exceeds 60% in adults aged ≥75 years; women bear a disproportionate share of this burden, both as patients and as caregivers. Meanwhile, the Italian National Health Service (Servizio Sanitario Nazionale, SSN) remains hospital-centric, regionally fragmented, and predominantly reactive, with prevention accounting for a historically modest share of total expenditure. Against this background, longevity medicine is an emerging, prevention-oriented discipline that aims to extend healthspan - defined here as the portion of life lived in good health, with preserved physical and cognitive function and without significant disability or multimorbidity. It integrates multi-omic biomarkers, digital monitoring, adaptive trial methodology, and life-course risk stratification within a translational framework. Although most constituent tools remain at an exploratory or surrogate stage, and clinical utility has yet to be established, the emphasis on early intervention and precision prevention offers potential to reduce the accumulation of age-related disease and ease long-term pressure on the SSN. This position paper analyzes Italy's demographic and epidemiological trajectory, examines the structural constraints of the SSN, and outlines the scientific foundations of longevity medicine. It advocates for multidisciplinary translational research and identifies five strategic investment priorities: (i) clinically validated biomarkers of biological age; (ii) interoperable digital monitoring platforms; (iii) Bayesian adaptive multimodal trials; (iv) explainable-AI risk stratification tools; and (v) longevity-informed curricula in medical training. These proposals should be regarded as a staged agenda for evaluation; their relevance will depend on whether they deliver measurable gains in patient-relevant outcomes, feasibility, and cost-effectiveness within the SSN.

This study investigates the impact of rapamycin and propranolol on cerebral cavernous malformations (CCMs). Employing an unbiased transcriptomic analysis, we aimed to comprehensively elucidate the molecular mechanisms underlying these drug effects. Mouse Brain Microvascular Endothelial Cells (mBMEC) deficient in Ccm3 were treated with propranolol or rapamycin and were analysed by RNA-seq and immunofluorescence. While propranolol shows limited efficacy in modulating the CCM transcriptomic phenotype in mBMEC, rapamycin demonstrates a significant impact. Rapamycin partially reverses gene expression changes induced by Ccm3 deficiency, restoring KLF2/4-dependent genes like Nos3, Adamts1, and Thbs1. Notably, we observed a reduction in KLF2 protein levels in Ccm3 KO cells treated with rapamycin. We also sought to determine whether rapamycin, especially in combination with the tyrosine kinase inhibitor lapatinib, which induces proapoptotic gene expression in Ccm3-deficient endothelium, can reduce lesion volume even after lesion growth has occurred. Ccm3iEC mice in which cavernoma development had been induced were treated with rapamycin alone or combined with lapatinib, assessing lesion volume using micro-CT imaging. Notably, a combination of rapamycin and lapatinib effectively reduces lesion volume in a chronic CCM model. In summary, our work reveals a mechanism by which rapamycin modulates Ccm3 KO endothelial cells and identifies rapamycin plus lapatinib as a possible combination therapy for cavernomas.

This study analyses, within Italian clinical practice, the epidemiology, healthcare resource utilization, and direct costs for the National Health Service (NHS) of patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM). From the ReS healthcare administrative database (4.6 million beneficiaries in 2022), patients with ATTR-CM were identified (2014-2022) through dispensation of tafamidis 61 mg or diagnosis of heart failure/arrhythmic cardiomyopathy with a compatible diagnostic work-up. Prevalence, clinical characteristics, mortality, treatments, healthcare resource utilization, and costs were estimated during the 1-year follow-up. 867 patients with ATTR-CM were identified in 2022 (male: 63%; mean age: 73 years; ≥3 comorbidities: 88.6%). During follow-up, 13% of patients died; 46% were hospitalized under ordinary care; 46.8% visited the emergency department; 96.5% received outpatient specialist care. Tafamidis 61 mg was dispensed to 49 patients (5.7%). The average annual cost per patient, borne by the NHS, was €17,284 (59.7% attributable to pharmaceuticals). The impact of ATTR-CM on the NHS is considerable, due to advanced patient age, multimorbidity, polypharmacy, and frequent hospitalizations, both related and unrelated to ATTR-CM.

Early Alzheimer's disease (AD) involves subtle cortical changes that may precede atrophy. Magnetic resonance imaging (MRI) microstructural markers may detect earlier pathology than classical morphometry. We analyzed cross-sectional MRI and amyloid-β (Aβ) positron emission tomography (PET) data from 1323 non-demented AMYPAD participants. Cortical volume, thickness, gray-white matter contrast (GWC), and mean diffusivity (MD) were related to global Aβ burden and estimated time to Aβ-positivity using regression, correlation, and change-point analyses. Microstructural measures showed stronger age associations than macrostructural measures, whereas all measures were unaffected by apolipoprotein E (APOE) -ε4 carriership. GWC and MD showed minimal overlap with volume and thickness. Higher Aβ burden was most strongly associated with reduced GWC and cortical thinning. Change-point analyses showed GWC alterations preceded Aβ-positivity by several years. Cortical microstructural MRI, particularly GWC, changes earlier than atrophy and may serve as an early in vivo marker of AD pathology.

Obesity has reached epidemic proportions globally, with its prevalence nearly tripling since 1975. It is now recognized as a chronic, relapsing disease associated with increased morbidity and mortality due to its strong relationship with several cardio-renal-metabolic conditions. This narrative review aims to explore the major obesity-related complications - namely obstructive sleep apnea syndrome (OSAS), metabolic dysfunction-associated steatotic liver disease (MASLD), dyslipidemia, and chronic kidney disease (CKD) - highlighting their pathophysiological mechanisms, clinical consequences, and current therapeutic strategies. Obesity contributes to OSAS by increasing upper airway collapsibility and to MASLD through ectopic fat accumulation, insulin resistance, and inflammatory responses. Dyslipidemia in obesity is characterized by elevated triglycerides, small dense LDL particles, and low HDL-C, driven by chronic inflammation and insulin resistance. CKD progression, particularly obesity-related glomerulopathy (ORG), is also mediated by metabolic and hemodynamic derangements, including renin-angiotensin-aldosterone system activation and glomerular hyperfiltration. Therapeutic interventions such as lifestyle modification, pharmacological therapy - including glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) - and bariatric surgery have shown efficacy not only in promoting weight loss but also in improving the clinical course of these obesity-related conditions. In particular, Very Low Energy Ketogenic Therapy (VLEKT) is emerging as a promising approach in improving metabolic parameters, hepatic steatosis, and cardiovascular risk factors. A comprehensive and multidisciplinary approach to obesity is essential, focusing not only on weight loss but also on mitigating associated complications. Effective management can significantly improve patients' quality of life and reduce the long-term burden of obesity on healthcare systems.

Falls in nursing home are a major problem, since risk factors for falls (such as muscular weakness, cognitive impairment, osteoporosis, balance and gait problems etc.) are more prevalent in this population than in community-dwelling individuals. Guidelines suggest that elderly people should be treated with vitamin D the whole year. In Nursing Homes vitamin D supplementation reduces falls, osteoporosis and respiratory infections, but it is undertreated in this environment. The main objective of this study was to see if there was any association between vitamin D supplementation and the frequency of falls in elderly people living in nursing homes in Andalucía, Spain. And, as a secondary objective, we wanted to see if there was association between the dosage of vitamin D and falls. This is a multicenter, observational, retrospective, cross-sectional, and analytic study with elderly individuals residing in nursing homes in 2023. 961 participants were included. Only 38.4% of the residents where receiving vitamin D supplementation. Most of them (60%) where taking cholecalciferol, 35% calcifediol, and only 5% where on combination of vitamin D with calcium. The supplement with the lowest association to falls was cholecalciferol (34.7%) (p value 0.05), and those residents taking cholecalciferol weekly where the ones with less falls (28.67%) (p value 0.02). Nursing home residents were undertreated with vitamin D, the dosage with the lowest association with falls was cholecalciferol weekly.

Breast cancer survivors (BCS) have an elevated risk of cardiovascular disease (CVD), but standardized follow-up protocols remain limited. We aimed to describe cardiovascular comorbidities and the utilization of specialized health services, particularly cardiology services, among BCS, and to examine their association with mortality. We conducted a retrospective cohort study of 6186 BCS diagnosed between 2000 and 2006 who survived at least 5 years after diagnosis. Participants were followed up from 2012 to 2016. Health care use and comorbidities obtained from electronic health records were analyzed. A multivariate time-dependent Cox proportional hazards model was used to assess the association between use of cardiology services and all-cause mortality. A total of 43.6% of long-term BCS had CVD at the beginning of follow-up. Women with CVD were older (mean age 71.8 vs 62 years; P<.001) and had a substantially higher comorbidity burden than those without CVD (5.83 vs 1.96; P <.001). During follow-up, 781 BCS (12.6%) died. Nonsurvivors were older and had a greater and more severe baseline comorbidity burden than survivors. They also had higher rates of specialist visits. Use of cardiology services was associated with lower mortality, although the association did not reach statistical significance (HR, 0.84; 95%CI, 0.67-1.05; P=.12). The prevalence of CVD among BCS was high, although only 18.8% used cardiology services. Nonsurvivors had a higher CVD burden and severity, and showed greater use of health care services.

Menstrual health plays a crucial role in health-related quality of life (HRQoL). However, there is a gap addressing HRQoL in relation to broader aspects of menstrual health definition. This study aims to analyse the relationship between menstrual health and self-reported health-related quality of life in women and people who menstruate (PWM)&#x2009;&#x2265;&#x2009;18 years in five regions of Spain (Andalusia, Basque Country, Canary Islands, Catalonia, and Galicia). A cross-sectional survey-based study with gender perspective was conducted. Thirty-two healthcare centres took part in the study across five regions of Spain between May and September 2023. Participants were women and PWM aged 18 or over with at least one menstruation in the last 6 months. Self-reported sociodemographic, menstrual health and HRQoL variables (using EQ-5D-5&#xa0;L scale) were collected. Descriptive statistics and linear regression models were performed. EQ-VAS scale was employed to perform sensitivity analyses. A total of 1,381 women and PWM were included (Mean age&#x2009;=&#x2009;34.63, SD&#x2009;=&#x2009;10.06). The mean of EQ-5D-5&#xa0;L index was 0.88 (SD&#x2009;=&#x2009;0.13) and EQ-VAS was 73.63 (SD&#x2009;=&#x2009;22.60). Several menstrual health variables were significantly associated with lower HRQoL. The strongest associations were observed for high frequency of premenstrual symptoms (&#x3b2;= -0.144; 95%CI= -0.139 to -0.090), high impact of premenstrual symptoms (&#x3b2;= -0.071; 95%CI= -0.102 to -0.040), high impact on social participation during menstruation (&#x3b2;= -0.104; 95%CI= -0.128 to -0.080), moderate frequency of menstrual poverty (&#x3b2;= -0.054; 95%CI= -0.078 to -0.029) and menstrual pain intensity (&#x3b2;= -0.047; 95%CI= -0.068 to -0.025). These findings highlight the substantial impact of menstrual health on HRQoL, particularly in some EQ-5D-5&#xa0;L domains (usual activities, anxiety/depression, and pain/discomfort). From a public health perspective, it is important to recognise menstrual health as a relevant component of overall well-being of women and PWM. Specifically paying greater attention to menstrual health relation to general pain, emotional health and participation in daily activities when designing health promotion and primary healthcare interventions.

Infarct growth rate (IGR) is highly heterogeneous among ischemic stroke patients, reflecting a spectrum of progressor phenotypes with clinical implications. We aim to compare different imaging approaches to investigate stroke progressors phenotypes and their clinical implications in patients undergoing thrombectomy. Data are from the prospective Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). Patients with M1/M2 occlusion and known symptom onset were included. Progressor phenotypes were defined using (1) NCCT-based definitions (ASPECTS points decay per hour&#x2009;<&#x2009;0.25 pts/h=slow progressor, 0.25-0.50 pts/h=intermediate, and >&#x2009;0.50 pts/h=fast); and (2) CTP-based definitions (CTP-estimated core divided by time of onset&#x2009;<&#x2009;5 mL/h=slow progressors, 5-10mL/h=intermediate, and >&#x2009;10 mL/h=fast). The primary outcome was 90-day good functional outcome (modified Rankin Scale [mRS]&#x2009;=&#x2009;0-2). Associations were assessed with logistic regression analyses adjusted for age, sex, NIHSS, TICI score, thrombolysis, and imaging-to-recanalization time. Of 26799 patients screened, 8322 (31.1%) were included (NCCT group: 8076; CTP group: 897 patients). NCCT-based progressor phenotype was associated with lower odds of good outcome (aOR 0.82 [95%CI&#x2009;=&#x2009;0.72-0.92] per each progressor phenotype increase). ASPECTS decay per hour was associated with lower odds of good outcome (acOR 0.94 [95%CI = 0.89-0.99]). No significant association was observed for either CTP-based progressor phenotype or CTP-based IGR (mL/h). Similar findings were observed for secondary outcomes. In this large, real-world cohort of stroke patients, NCCT-based IGR was associated with functional outcomes, whereas CTP-based IGR was not. This highlights the need to refine and identify more accurate markers of infarct growth within perfusion imaging.

While surveillance drug resistance mutations (SDRMs) remain essential for monitoring transmitted drug resistance (TDR), the clinical impact of transmitted resistance for current first-line regimens has become increasingly important. We aimed to update estimates of TDR in Spain and assess its clinical impact over time. This is a nationwide observational study within the CoRIS cohort. We estimated the prevalence of SDRMs and clinically meaningful resistance (CMR) among antiretroviral therapy (ART)-na&#xef;ve individuals with baseline genotypic resistance testing in 2022-2023 and evaluated annual trends in CMR to first-line regimens from 2007 to 2023. Clinically meaningful resistance was defined as Stanford HIVDB resistance level &#x2265; 3. In 2022-2023, 1028 individuals were included; 82.8% were male, 63.2% MSM, and 72.2% subtype B. Surveillance drug resistance mutation prevalence was 14.4% (95% CI 12.2%-16.9%), driven mainly by NNRTI-SDRMs, while INSTI-SDRMs remained rare [0.5% (95% CI 0.1%-1.5%)]; CMR to recommended first-line regimens was very low. Over 2007-2023, CMR declined markedly, coinciding with adoption of second-generation integrase inhibitors. Rilpivirine-associated resistance mutations were detected in 7.0%, largely due to E138A (4.8%). M184V was detected in 0.8%; 6 of 8 cases occurred in persons with current or prior oral pre-exposure prophylaxis (PrEP), although numbers were small. In Spain, TDR remains stable, but its clinical impact on first-line regimens has markedly declined. These findings support Test & Treat strategies and immediate ART initiation with contemporary triple- or dual-drug regimens, while highlighting the need for targeted resistance assessment for rilpivirine-containing regimens and further research on prior PrEP exposure and selected NRTI resistance patterns.

Obesity is known to have an intricate relationship with the development of Alzheimer's disease and dementia (mid-life obesity increases risk, whereas late-life adiposity may also have an effect). In this context, adipokines and satiety signals are suggested to play a role in late life, but their association with the incidence of these outcomes remains unclear. Our study aimed to assess whether five selected plasma adipokines and satiety hormones (leptin, ghrelin, resistin, adipsin, and fibroblast growth factor-21) were associated with incident Alzheimer's disease and dementia in older adults at high cardiovascular risk in a nested case-control study within the PREDIMED trial (90 dementia cases [73 of which were Alzheimer's disease], 156 controls). Participants were at high cardiovascular disease risk but free from dementia at baseline. Associations with biomarkers were assessed using multivariable conditional logistic regression. Higher resistin levels were associated with higher incidence of Alzheimer's disease in the multivariable-adjusted model (per one SD increase: OR 1.56, 95% CI 1.02 to 2.38); additional adjustment for body mass index slightly attenuated the association (OR 1.52, 95% CI 0.99 to 2.34). Our findings should be replicated in larger prospective studies but suggest that, despite the complex association between anthropometric measures and the incidence of dementia, high levels of resistin were tentatively associated with greater odds of incident Alzheimer's disease in older adults at high cardiovascular risk.

In the early time window, direct mechanical thrombectomy (MT) is not non-inferior to combined treatment with intravenous thrombolysis (IVT) for patients with large vessel occlusion (LVO) stroke, while its non-inferiority in the extended time window remains uncertain. This study assessed whether direct MT is non-inferior to IVT&#x2009;+&#x2009;MT beyond 4.5&#x2009;h or at wake-up. We emulated a non-inferiority trial, comparing direct MT vs. IVT&#x2009;+&#x2009;MT, including patients with anterior circulation LVO between 4.5 and 24&#x2009;h from symptom onset or at wake-up, without contraindications to IVT and with target perfusion mismatch. We used inverse probability weighting (IPW) adjusted for pre-specified covariates. The primary outcome was 90-day mRS 0-2, with non-inferiority defined by a lower 95% CI boundary of the Risk Difference (RD)&#x2009;&#x2265;&#x2009;-1.3%. Among 347 patients, 212 received direct MT and 135 received IVT&#x2009;+&#x2009;MT. After IPW, patients treated with direct MT and IVT&#x2009;+&#x2009;MT had a similar likelihood of achieving a 90-day mRS of 0-2 (adjRD -2.90 [95% CI -6.64 to 0.84]) with the lower boundary of the RD 95% CI crossing the non-inferiority margin. Additionally, direct MT was associated with a shift toward a higher score on the 90-day mRS (adjusted Common OR 1.59 [95% CI 1.05-2.39]), not confirmed after IPW, and with lower odds of successful recanalization (adjOR 0.38 [95% CI 0.18-0.78]). Rates of 90-day mRS 0-1, sICH, and mortality were similar between groups. In our target trial emulation, direct MT was not non-inferior to IVT&#x2009;+&#x2009;MT treatment beyond 4.5&#x2009;h from symptom onset or at wake-up, with IVT before MT yielding higher successful recanalization rates.

Increasing life expectancy has led to a growing older population and a higher prevalence of age-related declines in muscle mass, strength, and functional capacity, increasing the risk of frailty and sarcopenia. Although resistance and multicomponent exercise programs, particularly when combined with adequate protein and vitamin D intake, have demonstrated benefits, comparative evidence across exercise modalities remains limited. To compare the effects of different exercise modalities on muscle strength and functional mobility in older adults through a network meta-analysis (NMA). A systematic search was conducted from database inception to May 2026. Randomized controlled trials evaluating exercise interventions in older adults and reporting outcomes on Hand Grip strength (dynamometry) and Timed Up and Go (TUG) performance were included. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated with GRADE. Pairwise and network meta-analyses were performed to integrate direct and indirect comparisons. Forty-seven studies were included. For Hand Grip strength, the largest improvement was observed in multicomponent exercise combined with nutritional support versus control (effect size [ES]: 6.39; 95% CI: 0.48 to 12.30), followed by resistance training plus nutritional support (ES: 3.63; 95% CI: 0.44 to 6.82). For functional mobility, the greatest reduction in TUG completion time was found in multicomponent plus interventions versus control (ES: -1.88; 95% CI: -2.73 to -1.02), with superiority also demonstrated over conventional combined exercise (ES: -1.68; 95% CI: -3.25 to -0.11). Multicomponent exercise programs combined with nutritional support appear to provide the greatest improvements in muscle strength and functional mobility in healthy older adults. These findings support integrated exercise-nutrition strategies to preserve physical function with aging. High-quality trials are needed to refine optimal intervention components and dosing. The protocol for this review was registered in PROSPERO (CRD420251253057).

SARS-CoV-2 infection has been linked to an increased risk of hypertensive disorders during pregnancy, particularly preeclampsia (PE). As both conditions involve vascular and endothelial dysfunction, a mechanistic overlap has been proposed. This study examines the relationship between maternal COVID-19 and preeclampsia by analyzing inflammatory, endothelial, and angiogenic biomarkers in pregnancies with and without these complications. A case-control study was conducted, including four groups: healthy pregnancies before 2020 (n = 10), preeclampsia cases before 2020 (n = 10), COVID-19 cases without preeclampsia (n = 10), and COVID-19 cases with preeclampsia (n = 10). The groups were selected to be comparable in terms of gestational age at blood sampling. Biomarkers related to endothelial, inflammatory, and angiogenic pathways were measured. Significant differences in biomarker levels were detected among the four groups. Regarding endothelial damage, sICAM1 levels were significantly higher in the COVID-PE group compared with the COVID-noPE group (p = 0.002). Additionally, vWF (p = 0.006), END1 (p < 0.001), and sVCAM1 (p = 0.030) levels varied significantly across groups. IL8 levels showed significant differences (p < 0.001), and were particularly elevated in preeclampsia cases (preCOVID-PE and COVID-PE groups) compared with controls (p = 0.005 and p < 0.001, respectively). Angiogenic markers sFlt-1, PLGF, and sFlt-1/PLGF exhibited significant group differences (p < 0.001). In contrast, maternal SARS-CoV-2 infection in the absence of preeclampsia was not associated with a significant alteration of the sFlt-1/PlGF ratio. PE associated with SARS-CoV-2 infection preserved the classical angiogenic signature of preeclampsia, but showed additional endothelial and inflammatory biomarker alterations. These findings support an association between SARS-CoV-2 infection and a distinct endothelial and inflammatory biomarker profile in PE, warranting confirmation in larger prospective studies.

The advancement of digital technologies has integrated mobile phone use into both daily and professional life. However, excessive use has led to the emergence of nomophobia (an irrational fear of being without one's device), which may act as a source of distraction in healthcare settings, potentially compromising patient safety and the quality of care. The aim of this study was to explore mobile phone use and the unfinished nursing care among Primary Care and Hospital nursing professionals. A descriptive cross-sectional study was conducted among 161 nursing professionals in Almer&#xed;a, Spain. The Nomophobia Questionnaire (NMP-Q) and the Unfinished Nursing Care Survey (UNC) were used. Data were analyzed using descriptive statistics, nonparametric tests (Mann-Whitney U test and Spearman's correlation), and a multiple linear regression model (p&#x202f;<&#x202f;0.05). Participants showed moderate levels of nomophobia (M =&#x202f;65.8; SD&#x202f;=&#x202f;22.1) and a moderate-to-high prevalence of unfinished nursing care (M =&#x202f;109.4; SD&#x202f;=&#x202f;28.1). Significantly higher levels of nomophobia were found among hospital-based professionals (p&#x202f;=&#x202f;0.041) and those who expressed a desire to change units (p&#x202f;=&#x202f;0.042). No significant differences were observed by sex, although women reported higher scores. Regression analysis confirmed that nomophobia is a significant predictor of unfinished nursing care (&#x3b2;&#x202f;=&#x202f;0.211; p&#x202f;=&#x202f;0.002), explaining 24.7% of the variance in the model. Nomophobia shows a moderate prevalence among nursing professionals and is associated with unfinished nursing care. Mobile phone use may function as a cognitive avoidance mechanism in response to work-related stress; however, inappropriate use increases distractions and missed care. It is therefore necessary to develop institutional policies and awareness programs to regulate its use, in order to ensure safe, humanized, and efficient care.

Background/Objective: Service-learning is an educational methodology that has demonstrated benefits and effectiveness in nursing education, generating positive outcomes for both students and the community. However, its application in cardiopulmonary resuscitation (CPR) training remains underexplored. This study explored nursing students' perceptions of CPR training through service-learning, focusing on dimensions of learning, emotional experience, professional identity, and perceived difficulties in implementation. Methods: A descriptive qualitative study was conducted with 30 nursing students selected through purposive sampling. Data were collected via semi-structured interviews, which were audio-recorded, transcribed verbatim, and thematically analyzed using ATLAS.ti. Results: Four main themes emerged: (1) meaningful learning and consolidation of competencies; (2) emotional impact associated with teaching CPR; (3) increased social awareness and strengthening of professional identity; and (4) perceived difficulties and barriers in implementing service-learning. Conclusions: The results suggest that nursing students perceived service-learning in CPR training as a meaningful learning experience, associated with greater self-confidence, greater emotional engagement, and greater social awareness, despite the perceived barriers.

Early fluid management may influence disease severity and long-term kidney outcomes in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS). We evaluated the association between early volume expansion and severe long-term kidney sequelae. We conducted a multicenter retrospective cohort study including children with STEC-HUS and severe acute kidney injury, defined by the need for dialysis for at least 48&#xa0;h. Kidney outcome at follow-up was classified according to estimated glomerular filtration rate (GFR) as normal kidney function or chronic kidney disease stage 1 versus chronic kidney disease stages 2-5. A total of 232 children were included. Median age was 2.34&#xa0;years (interquartile range 1.6-4). At the end of follow-up (median 4.8&#xa0;years, interquartile range 3.2-6.6), 72 patients (31%) had kidney sequelae corresponding to chronic kidney disease stages 2-5. Early volume expansion was performed in 102 patients (44%). These patients required dialysis for a shorter duration, had higher estimated GFR at follow-up, and less frequently developed chronic kidney disease stages 2-5. Lack of early volume expansion was independently associated with higher odds of kidney sequelae (odds ratio 2.46, 95% confidence interval 1.25-5.03), as was longer dialysis duration (odds ratio 1.10 per day, 95% confidence interval 1.05-1.15). Estimated GFR at follow-up was inversely correlated with dialysis duration; this association was not evident in patients who received early volume expansion but remained significant in those who did not. Early volume expansion and shorter dialysis duration were associated with long-term improved kidney outcomes.

The objective of this paper is to describe and analyse the healthcare reform project in Chile following the 2019 social uprising. It outlines the progress, obstacles, and challenges within its historical context. Chile presents very positive health indicators, but also marked inequities stemming from the existing inequality in the country. The Chilean healthcare system has experienced a pendulum swing throughout its history, going from being one of the first integrated healthcare services in Latin America to becoming one of the best examples of the neoliberal model, before attempting to transition once again toward a social protection system with universal access and coverage. The arrival of President Boric to power in 2022 was accompanied by a program that established a conception of health as a social right, generating an agenda of transformations in the sector, consistent with the principles of universal healthcare. Although significant progress has been made (zero co-payments, universal Primary Health Care), the inability to pass the tax reform that would guarantee the structural financing of these changes, along with the difficulties in creating a Universal Health Fund and advancing the transformation of private health insurers (Isapres) into supplementary insurance providers, has significantly limited the scope of these transformations. The difficulties observed in Chile in moving towards a single insurance model demonstrate that the dismantling of welfare states proceeds much more easily than the strengthening of social protection.