Rocío Llamas-Ramos

Syrian refugees face numerous challenges, including conflict, displacement, family separation, human rights violations, limited access to basic needs, and exposure to violence and torture. These experiences significantly affect their physical, psychological, social, and environmental quality of life (QoL). The aim of this study was to assess the QoL of Syrian refugees in Spain and Jordan and to examine the association between sociodemographic characteristics, living conditions, and experiences of discrimination with different QoL domains. This study used a cross-sectional correlational design in Syrian refugee centers, homes, and camps across Spain and Jordan. A convenience sample of Syrian refugees with confirmed status in the past ten years was recruited. Demographic data were collected via a demographic form, and the World Health Organization Quality of Life—Brief Questionnaire (WHOQOL-BREF) was used to assess their quality of life. Data analysis included descriptive statistics, Chi-square tests, one-way ANOVA, and independent t-tests. The two hundred participants were predominantly aged 18–29 (43%), female (52.5%), married (51.5%), with secondary school education (46.5%), and unemployed (70%), with low monthly family income (60.5%). While 69% experienced low levels of discrimination, 33% were satisfied with their health, and 47.5% rated their QoL as neutral. Refugees in Spain reported higher QoL across physical, psychological, social, and environmental domains compared to those in Jordan (p < 0.05). The QoL was related to socio-demographic factors: higher among married participants (p = 0.044), urban residents (p < 0.001), and recent immigrants (p < 0.001), but lower among those with low income (p = 0.011). Gender differences showed that males had better physical (p = 0.001) and psychological (p = 0.032) QoL than females. Lower discrimination levels and employment were associated with higher QoL across multiple domains. This study highlights the lasting association of the Syrian conflict on refugees’ QoL, emphasizing the need for holistic healthcare that addresses physical, psychological, social, and environmental challenges both before and after displacement. Findings call for comprehensive support systems, including early mental health interventions, anti-discrimination efforts, and community inclusion programs, to enhance refugees’ resilience and integration. The study identifies specific subgroups at greater risk of lower QoL—including women, older adults, those with low income, the unemployed, camp residents, and those experiencing discrimination—providing actionable insights for policymakers to target resources and interventions effectively. Tailored rehabilitation and psychological care are essential for empowering refugees to rebuild their lives and fostering social cohesion in host communities.

Background/Objectives: Older adults residing in long-term care frequently experience multimorbidity, low habitual activity, mobility decline, executive dysfunction, and reduced quality of life. Evidence separating the effects of exercise, cognitive stimulation, and their combination remains limited. The primary objective of this trial is to determine whether a 12-week combined physical exercise plus cognitive stimulation programme improves executive function, functional mobility, and health-related quality of life compared with usual care. Secondary objectives are to estimate the effects of each single-component programme, compare the combined programme with each component, and examine maintenance at six months. Methods: This is a four-arm, parallel-group, assessor-blinded randomised controlled trial in Portuguese long-term care facilities. A total of 140 residents aged 65 years or older, residing in long-term care for at least three months and able to provide informed consent, will be allocated 1:1:1:1 to supervised multicomponent exercise, group cognitive stimulation, combined exercise plus cognitive stimulation, or usual care. Active programmes will be delivered three times weekly for 12 weeks. Assessments are planned at baseline, post-intervention, and six-month follow-up according to the prespecified schedule. Primary outcomes are the Stroop interference score, Timed Up and Go time, and EQ-5D-5L index value at 12 weeks. Analyses will follow the intention-to-treat principle using mixed-effects models; multiplicity across the three primary endpoints will be controlled using Holm’s procedure, and interaction analyses will be exploratory and hypothesis-generating. Results: Recruitment and data collection had not started at manuscript submission; therefore, no participant data are reported. Conclusions: The trial will estimate the effects of the combined programme versus usual care and provide exploratory comparative evidence on the single-component programmes in real-world long-term care.

Background: Central nervous system development is a rapid and highly plastic process during the first years of life. Tactile stimuli have been shown to induce cortical changes, but potential sex-related differences remain unexplored. This study aimed to investigate sex-specific differences in cortical activity and cerebral oxygenation in response to tactile stimulation via body massage. Methods: Four healthy full-term infants (two females and two males), all aged 11 weeks, were included in this prospective exploratory study. Each infant received a standardized 5 min massage protocol. Cortical activity and cerebral oxygenation were assessed using an 8-channel electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) before, during, and after the intervention, with a 5 min pre-intervention resting period used as the baseline. Results: EEG analysis focused on a single spectral band (4 Hz–30 Hz). This range was selected to capture the main cortical oscillations in infants, including theta, alpha, and beta activity, while delta activity below 4 Hz was partially excluded to reduce movement and physiological artifacts. Standard infant EEG bands were considered when defining this range. Data shows for the female subject an average PSD of −6.726 (± −4.075), and for the male subject, −12.594 (± −10.741). Although babies are of the same gestational age, they exhibited distinct basal cortical activity, which prevented comparisons from being made. Nevertheless, massage induced similar activity patterns in all subjects with increased cortical electrical activity in the left parietal region relative to baseline. fNIRS data showed that comparable HbO concentration patterns between participants were observed only during the second minute of recording. Relative to baseline, pre-intervention HbO responses displayed an opposite distribution, and the effects of the intervention differed by sex. The female participant exhibited a slight reduction in activation in the right hemisphere accompanied by a modest increase in the most ventral region of the left hemisphere. Conversely, the male participant showed an inverse response pattern, characterized by a marked increase in right hemispheric activation and a pronounced decrease in the left hemisphere during the intervention period. Conclusions: These preliminary observations suggest the presence of early variations in cortical processing that warrant further investigation in larger samples, although they cannot be considered conclusive. While baseline response patterns differed between participants, both showed increased left parietal activity during tactile stimulation. The inversion of HbO responses between the pre-intervention and intervention phases points to potential sex-related differences in hemodynamic trajectories. Nevertheless, these results remain preliminary, and larger, well-powered studies are required to determine whether these patterns reflect stable, sex-dependent developmental changes.

Background: Cancer cachexia and sarcopenia are highly prevalent complications affecting up to 50% of patients with cancer and are associated with increased treatment toxicity, poorer functional outcomes, and reduced survival. Early identification of muscle deterioration during hospitalization remains challenging. Objective: To evaluate the change in dominant-hand handgrip strength between hospital admission and discharge in hospitalized oncology patients. Methods: This prospective longitudinal study will evaluate hospitalized adults with confirmed malignancy and an expected hospital stay of ≥5 days. Daily handgrip strength and sEMG assessments will be performed as exploratory secondary measures to characterize temporal patterns of muscle function during hospitalization. Baseline and discharge evaluations will additionally include bioelectrical impedance analysis, validated patient-reported outcome measures (SARC-F, EORTC QLQ-C30, PSQI), and serum biomarkers related to inflammatory and nutritional status. Linear mixed models will be used to evaluate longitudinal changes and associations between functional, electrophysiological, and biochemical parameters. Expected results: The study aims to characterize trajectories of muscle function decline during hospitalization, identify candidate biomarker signatures for cachexia detection, and evaluate neuromuscular fatigue patterns using sEMG. Conclusions: This protocol proposes a feasible multimodal framework for monitoring skeletal muscle deterioration during acute oncology hospitalization and may inform future interventional strategies targeting cancer-related cachexia and sarcopenia.

Background and Clinical Significance: Understanding early brain development in infants is essential as identifying an abnormal pattern could accelerate the start of early interventions. There is still limited evidence on how external stimuli (such as tactile, auditory, and visual inputs) influence cortical electrical activity, underscoring the need for integrative studies comparing these modalities in the first months of life. The objective of this paper is to determine the effects of different stimuli (tactile, auditory, and visual) in cortical electrical activity to take advantage of its use in individualized protocols and treatments. Case Presentation: An 8-channel electroencephalography cap was placed on the infant’s head to analyze 10 different conditions depending on the selected stimuli: Kangaroo Care with mother and father, rest, tactile stimuli, visual stimuli, acoustic stimuli, and sleep for 5 min. The environment was the same in all conditions to ensure comparison. All conditions have been able to modify the cortical electrical activity presenting different patterns of electrical activity. Tactile stimuli (massage) showed increased activity in the left parietal region. Acoustic stimuli showed increased activity in the frontal region. Visual stimuli presented different patterns, but with a higher occurrence of artifacts due to baby’s movement. Conclusions: Acoustic stimuli with music increased cortical electrical activity in frontal region, while tactile stimuli increased the left cerebral hemisphere activity. Future studies are needed to support these exploratory results to establish early interventions in pathological conditions.

Background: Displaced individuals endure challenges, including conflict, forced migration, family separation, human rights violations, limited access to essential services, and increased exposure to violence and abuse. These hardships significantly impact their mental health, often leading to heightened trauma-related symptoms. Methods: We used a cross-sectional correlational design in refugee camps, homes, and centers across Jordan and Spain. 200 refugees with confirmed status in the past ten years were recruited. Demographic data were collected via a demographic form, the PTSD-8 Inventory assessed traumatic symptoms, and data analysis included descriptive statistics, independent t-tests, one-way ANOVA, and Chi-square tests. Results: Most participants had a secondary education, were unemployed, and had low incomes. PTSD symptoms were prevalent, with rates of recurrent thoughts (63.5%), re-experiencing events (57.5%), nightmares (50.5%), sudden reactions (56.5%), activity avoidance (53.5%), avoidance of specific thoughts or feelings (56.5%), jumpiness (53.5%), hypervigilance (53.5%), feeling on guard (41.5%), and general avoidance (43.5%) rated from rarely to most of the time. All symptoms were significantly more frequent among refugees in Jordan than in Spain. Conclusions and Recommendations: Intrusive thoughts were more frequent among females, urban residents, and unemployed individuals. Avoidance behaviors were higher in married and unemployed individuals. Hypervigilance was more prevalent among females, married individuals, and those with lower incomes. Regionally, females and married individuals in Jordan exhibited more intrusive thoughts and avoidance. In Spain, intrusive thoughts and hypervigilance were more common among females and the unemployed. The findings highlight the urgent need for targeted mental health interventions, particularly in refugee camps like those in Jordan, where PTSD symptom rates were significantly higher. Programs should prioritize trauma-focused therapies, such as Cognitive Behavioral Therapy, while adopting gender-sensitive approaches to address the heightened vulnerability of women and unemployed individuals. Given the strong link between unemployment and symptom severity, livelihood support and vocational training should be integrated into psychosocial care. Policymakers in host countries like Jordan could benefit from adopting integration strategies similar to Spain’s, which may contribute to lower PTSD prevalence. Additionally, community-based awareness initiatives could improve early symptom recognition and access to care. Future research should explore longitudinal outcomes to assess the long-term impact of displacement and resettlement conditions on mental health.

Background: Vascular aging, characterized by a progressive increase in arterial stiffness, is associated with an increased risk of cardiovascular disease. The Mediterranean diet (MD) has been shown to have protective effects on cardiovascular health, but its relationship with vascular aging, as assessed by the Cardio-Ankle Vascular Index (CAVI), is not yet well established. Objective: To analyze the association between adherence to the MD and vascular aging estimated with CAVI in a sample of Spanish women with no history of previous cardiovascular disease. Methods: A cross-sectional study was conducted in 1468 women (aged 30–80 years), classified into three categories according to CAVI: healthy vascular aging (HVA), normal (NVA), and early (EVA). Adherence to the MD was assessed using the MEDAS questionnaire validated in Spain. ANOVA and chi-square tests were used to compare baseline characteristics, and multinomial logistic regression was used to analyze the association between MD adherence and vascular aging status, adjusting for age, sex, and drug treatment. Results: The CAVI increased progressively with age (p < 0.001) and was associated with higher blood pressure, dyslipidemia, hyperglycemia, and diabetes mellitus. Adherence to the MD was significantly higher in groups with lower arterial stiffness (p < 0.001). In the multivariate analysis, greater adherence to MD was associated with a higher probability of healthy vascular aging compared to NVA (OR: 1.872; 95% CI: 1.366–2.566; p < 0.001) and EVA (OR: 1.738; 95% CI: 1.363–2.218; p < 0.001). Conclusions: Greater adherence to the MD is associated with a healthier vascular aging profile. Promoting this dietary pattern may be an effective strategy for preventing arterial stiffness and reducing the cardiovascular risk associated with aging.

Handball is one of the Olympic sports with the highest incidence of injury and chronic ankle instability is a common injury among handball players. Strong evidence shows the relevance of the core system in lower limb biomechanics and injury risk; however, few research has been published regarding the role of the active subsystem of the core on chronic ankle instability. The objective has been to compare abdominal wall morphology and function between young handball players with and without chronic ankle instability. Case–control study with 100 young handball players, 50 males participants and 50 females participants, was recruited and divided into athletes with chronic ankle instability (case group, n = 50) and healthy athletes (control group, n = 50). Main outcome measures were morphology and function of abdominal muscles and the inter-recti distance assessed by ultrasound examination. Significant between-group differences were found in the resting assessment of right rectus abdominis (case group 1.12 cm; control group 1.04 cm; p = 0.049), left rectus abdominis (case group 1.16 cm; control group 1.06 cm; p = 0.037), left internal oblique (case group 1.00 cm; control group 0.88 cm; p = 0.012), left transversus abdominis (case group 0.38 cm; control group 0.34 cm; p = 0.039) and inter-recti distance (case group 1.20 cm; control group 1.40 cm; p = 0.049). Moreover, significant between-sex differences were found in almost all morphological outcomes; muscle size at rest was larger in male handball players than in women counterparts. By contrast, no significant differences were found for function outcomes. Young handball players with chronic ankle instability had greater resting thickness of some abdominal muscles and lower inter-recti distance when compared to healthy athletes.