Marcelino Pérez-Bermejo

Background: Loneliness in older adults is a global public health problem. Although robust evidence exists regarding its consequences, the evidence base is marked by a bias towards high-income countries and urban contexts. The rural Peruvian Amazon is a territory virtually absent from the scientific literature on ageing and loneliness. Methods: We conducted a descriptive–interpretive qualitative study based on 34 semi-structured interviews with adults aged 60 years and over, recruited through Cáritas-Requena. Analysis followed the reflexive thematic analysis framework. Purposive sampling with maximum variation criteria was employed. The study was complemented by a quantitative characterisation using the Barthel Index, the LSNS-6 scale, and the DUKE-UNC-11 questionnaire. Results: Four themes emerged: (1) structural and functional conditions as the substrate of loneliness; (2) family reconfiguration driven by internal migration, with notable prominence of skipped-generation households (grandparents caring for grandchildren); (3) lived experiences of emotional and social loneliness, including a contextual pattern of feeling lonely despite the physical presence of others, which we descriptively label “paradoxical loneliness”; and (4) coping resources, including faith, work, neighbourhood networks, non-human companionship, and habituation. The descriptive relational measures showed different distributions: objective social isolation (LSNS-6 < 12) was observed in 12.5% of participants, whereas low perceived functional social support (DUKE-UNC-11 < 32) was observed in 68.8%; these measures assess distinct constructs and were used solely to contextualise the qualitative findings. Conclusions: Among the service-connected older adults included in this study, loneliness was shaped by the interaction of family reconfiguration, material and health-related conditions, and locally available coping resources. The experience of feeling lonely despite the physical presence of others was compatible with Perlman and Peplau’s cognitive discrepancy model and is presented here as a context-specific interpretive pattern rather than as an independent dimension of loneliness.

Background/Objectives: Dental caries remains a major public health problem in childhood and disproportionately affects socioeconomically disadvantaged populations. Although toothbrushing and oral hygiene are commonly promoted as key preventive behaviours, their protective effect may be limited by structural factors such as access to dental care, fluoride exposure, and preventive services. This study aimed to compare dental caries experience, oral hygiene status, toothbrushing frequency, and sugar consumption among disadvantaged children from the Peruvian Amazon and Valencia, Spain, and to explore whether differences in hygiene behaviours were reflected in caries outcomes. Methods: An exploratory cross-sectional school-based study was conducted among 291 children aged 5–12 years attending three purposively selected schools serving socioeconomically disadvantaged communities: one rural school in the Peruvian Amazon (n = 162) and two urban schools in Valencia, Spain (n = 129). Dental caries experience was assessed using a combined global caries score derived from the dmft and DMFT (CAOD/cod) indices according to dentition type, and oral hygiene status was evaluated using the Simplified Oral Hygiene Index (OHI-S). Toothbrushing frequency and sugar consumption were collected through structured questionnaires. Group comparisons, Spearman correlation analyses, and exploratory multiple linear regression models were performed. Results: Mean global caries scores did not differ significantly between Peruvian and Spanish children (3.71 ± 2.86 vs. 4.07 ± 3.44; p = 0.596). However, severe caries experience (score ≥ 8) was more frequent among Valencian children (21.7% vs. 10.5%; p = 0.014). Peruvian children showed significantly better oral hygiene status (OHI-S-derived score: 1.25 ± 0.79 vs. 1.49 ± 0.84; p = 0.014) and higher toothbrushing frequency (p < 0.001). Frequent sugar consumption was similarly high in both groups. Within each population, poorer oral hygiene and lower toothbrushing frequency were associated with higher caries experience in bivariate analyses, although the exploratory multivariable models showed a more limited pattern of association. Conclusions: Among the participating schools, children from the Peruvian Amazon showed better oral hygiene indicators and more frequent toothbrushing than Spanish children, while no statistically significant difference in caries experience was detected. Because structural variables such as fluoride exposure, dental attendance, and access to restorative care were not directly measured, explanations involving healthcare infrastructure should be considered as candidate hypotheses to be tested in future, adequately powered and adjusted studies, rather than as confirmed mechanisms. Findings should not be generalised beyond the participating schools.

Background/Objectives: Dental caries is socially patterned, but the magnitude of the inequality associated with social exclusion is difficult to quantify when populations are compared across different countries and health systems. This study estimated the oral health gap between socially vulnerable children attending escuelas singulares and a contemporaneous reference paediatric population attending university dental clinics within the same city and health-system context. Methods: A cross-sectional analytical study was conducted in 231 children aged 6–12 years in Valencia, Spain: 129 from two state-funded schools serving communities at high risk of social exclusion, hereafter referred to as escuelas singulares (Colegio Madre Petra, n = 64; Colegio Santiago Apóstol, n = 65), and 102 reference children examined at the University Dental Clinics of the Catholic University of Valencia. Caries experience (DMFT/dmft-derived global score), the Simplified Oral Hygiene Index (OHI-S), toothbrushing frequency and sugar consumption were recorded under standardised conditions. The groups were compared with non-parametric tests, and multivariable logistic and modified Poisson regression models estimated the independent association (adjusted OR and adjusted prevalence ratio, respectively) between school context and the presence of caries, adjusting for age, sex and behaviours. Results: Caries experience was markedly higher in vulnerable children (global caries score 4.07 ± 3.44 vs. 0.61 ± 1.96; p < 0.001), with a caries prevalence of 76.0% vs. 13.7% (a prevalence ratio of 5.5) and a 6.7-fold higher mean burden. Only 24.0% of vulnerable children were caries-free versus 86.3% of reference children. Vulnerable children also showed poorer oral hygiene (OHI-S 1.49 ± 0.84 vs. 0.19 ± 0.34; p < 0.001), less frequent brushing (50.4% vs. 79.4% brushing ≥ twice daily; p = 0.002) and higher sugar consumption (p < 0.001). After adjustment for age, sex, brushing and sugar, attendance at an escuela singular was associated with an adjusted prevalence ratio of 5.4 (95% CI 3.3–8.9; primary effect measure) and, in a secondary logistic model, with an adjusted OR of 20.5 (95% CI 9.6–43.8). Conclusions: Within a single high-income setting with formally universal health coverage, social exclusion was associated with a very large, graded excess of childhood caries that the measured behavioural differences alone were unlikely to explain, underscoring the role of social and structural determinants beyond individual behaviours. These cross-sectional findings are consistent with proportionate-universalism strategies (targeted, school-based preventive and restorative care embedded within the universal system), since formal coverage alone may be insufficient to achieve oral health equity.

Background and Objectives: Malnutrition and frailty affect 30–55% of intensive care unit (ICU) patients, yet formal nutritional screening remains inconsistently implemented in routine ICU admission workflows. The APACHE II score, the standard measure of acute physiological severity, does not capture pre-existing nutritional status or functional reserve. The Norton scale, routinely recorded by nursing staff for pressure-ulcer screening, could serve as a pragmatic proxy for the nutritional-functional axis. We assessed its independent prognostic value at admission for in-hospital and post-ICU mortality. Materials and Methods: Retrospective cohort study of 5775 consecutive adult patients admitted to a Spanish tertiary polyvalent ICU between 2012 and 2019, with APACHE II and Norton scores recorded at admission. The Norton was analysed as continuous and categorised (minimal >14, medium 13–14, high 10–12, very high 5–9). Discrimination was assessed by AUC and DeLong’s test, predictive improvement by IDI and NRI, and internal validity by bootstrap resampling (B = 200). Results: Hospital mortality was 12.8% (n = 738), rising from 7.7% in patients with minimal-risk Norton to 34.5% in very high risk. After adjustment for APACHE II, each additional Norton point reduced the odds of death by 7.7% (adjusted OR = 0.923; 95% CI 0.903–0.943). Adding the Norton to APACHE II improved discrimination (AUC 0.865 → 0.872; DeLong p = 0.003; IDI = 0.011; continuous NRI = 0.30). In the highest APACHE II quartile, the absolute mortality difference between minimal and very high Norton categories reached 23.2 percentage points. The Norton’s prognostic effect was approximately twice as large for post-ICU mortality (ΔAUC +0.011) as for overall in-hospital mortality (ΔAUC +0.006). Conclusions: The Norton scale at admission improves the prognostic capacity of APACHE II in critically ill patients, particularly for post-ICU mortality. Its widespread availability without additional patient-level data collection positions it as a pragmatic candidate for routine prognostic assessment and for guiding targeted nutritional screening.

Background: Lung cancer carries a high psychosocial burden. Tobacco use, the stigma attached to the disease, and coping strategies are thought to interact and shape psychological outcomes, yet they have rarely been examined together. This review aimed to synthesise the evidence on the relationship between tobacco use, lung cancer stigma, and coping, and how these factors interact and influence patients’ psychological outcomes. Methods: Following the PRISMA 2020 guideline, PubMed/MEDLINE and Dialnet were searched (window 2014–April 2026) for empirical studies conducted in adults with lung cancer that addressed stigma, coping, or relevant psychological outcomes (e.g., anxiety, depression, distress, or quality of life). Study selection and data extraction were performed independently by two reviewers, with discrepancies resolved by consensus and, where needed, by a third reviewer. Methodological quality was appraised with design-specific tools (JBI for cross-sectional and cohort studies, CASP for qualitative studies, and COSMIN-oriented criteria for the psychometric study). Given the clinical and methodological heterogeneity, a structured narrative synthesis was conducted following the SWiM guideline. The protocol was registered in the Open Science Framework. Results: Twenty-four studies were included. Stigma was prevalent and consistently associated with depression, anxiety, distress, and poorer quality of life, with longitudinal evidence indicating that stigma precedes and predicts distress. Internalised stigma (guilt, shame, self-blame) was the facet most strongly linked to depression and anxiety. Smoking history graded stigma intensity (current > former > never smokers) but did not determine it, since clinically significant stigma also affected never-smokers. Adaptive coping (e.g., fighting spirit, positive reappraisal) and social support were consistently associated with better psychological adjustment and quality of life, while maladaptive coping (e.g., helplessness, avoidance, anxious preoccupation) was associated with worse outcomes; cross-sectional evidence further indicated that coping modes mediated the relationship between stigma and quality of life and that social support and self-compassion attenuated the impact of stigma on distress. Conclusions: Internalised stigma is a central, modifiable psychosocial stressor in lung cancer that affects smokers and never-smokers alike. Systematic screening for stigma, coping, and social support, together with non-stigmatising care, is warranted.

Background/Objectives: The nutrition transition in low- and middle-income countries has produced a double burden of malnutrition (coexistence of excess weight, undernutrition, and micronutrient deficiencies), with scarce evidence in schoolchildren from vulnerable peri-urban areas of Paraguay. The objective was to characterize, in a multidimensional way, the nutritional status of children and adolescents from Limpio and to explore its associations with anemia and clinical, dietary, and environmental variables, in particular, reported intestinal parasitosis. Methods: Cross-sectional observational study in 90 participants aged 6 to 16 years recruited by convenience at six community settings. Anthropometry, body composition, capillary hemoglobin, dietary patterns, and environment were assessed. Weight status was classified using the WHO 2007 references (z-scores), anemia was described using WHO thresholds, and central obesity was assessed using a waist-to-height ratio > 0.5. Non-parametric tests, Fisher’s exact test, Spearman correlations, and multivariable logistic regression were used. Results: Overweight or obesity affected 39.3% (obesity, 16.7%) and central obesity 22.4%, with no cases of thinness, coexisting with anemia (27.0%), stunting (8.2%), and reported intestinal parasitosis (24.1%). Anemia was more frequent in children with reported intestinal parasitosis (45% versus 20%; adjusted OR 5.44; 95% CI 1.44–20.51). Height-for-age was inversely associated with the number of siblings (ρ = −0.25). Conclusions: This population showed a double burden of malnutrition. The association between reported, non-laboratory-confirmed intestinal parasitosis and capillary-hemoglobin-defined anemia was exploratory and non-causal, given the cross-sectional design. Together with the high burden of anemia, these findings raise the hypothesis of a possible triple burden of malnutrition, which would require confirmation through stool parasitological testing and biomarkers of iron status, inflammation, and other micronutrients. These findings are compatible with integrated community strategies addressing dietary quality, sanitation, and access to safe water; decisions on deworming and micronutrient supplementation should be guided by local parasitological surveillance and biomarker-based assessment rather than by these data alone. Because the study used a convenience sample from a single peri-urban community during one fieldwork period, the findings should not be generalized beyond similar vulnerable settings without further confirmation.

Background/Objectives: Metastatic triple-negative breast cancer (mTNBC) carries a poor prognosis and limited treatment options. Sacituzumab govitecan (SG), an anti-Trop-2 antibody–drug conjugate, has shown activity in this setting, but a quantitative synthesis integrating randomized and real-world evidence—particularly in underrepresented subgroups—was lacking. We aimed to summarize the comparative benefit of SG, which derives from a single randomized trial, and to assess whether trial-level efficacy is consistent with the activity observed in routine practice. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE and Web of Science (January 2017–April 2026) for trials and observational cohorts of SG monotherapy in mTNBC. Comparative effects were taken from randomized data; single-arm efficacy (objective response rate [ORR], clinical benefit rate [CBR], median progression-free [PFS], and overall survival [OS]) was pooled using random-effects models. Risk of bias was assessed with RoB 2 and ROBINS-I. The review was registered in the Open Science Framework. Results: Nine studies (1242 patients; 980 SG-treated) were included: one randomized trial (ASCENT), two single-arm trials, and six real-world cohorts. In ASCENT, SG improved PFS (hazard ratio [HR] 0.41, 95% CI 0.33–0.63) and OS (HR 0.51, 0.42–0.64). Pooled ORR was 31.1% (28.0–34.4), and CBR was 42.2% (37.7–46.8), with the median PFS being 4.8 months (4.4–5.3) and OS being 11.0 months (9.3–13.0); trial-derived and real-world estimates were concordant. The benefit persisted in older patients (HR 0.25) and Black women (HR 0.44) but not in those with brain metastases (HR 0.68, 0.38–1.23). Conclusions: SG shows clinically meaningful activity in mTNBC that is broadly consistent between controlled trials and routine practice. Comparative superiority over chemotherapy rests on a single randomized trial (ASCENT); the pooled single-arm estimates describe activity and its consistency rather than a comparative effect.

Injury epidemiology in basketball has traditionally focused on incidence and injury type, with limited attention to how injury burden is distributed within teams. Understanding the distribution of time-loss may provide a complementary perspective on the impact of injuries on player availability. The aim of this study was to describe injury epidemiology and to analyze the distribution and inequality of injury burden during a competitive season in elite basketball players. A retrospective longitudinal observational study was conducted using routinely collected clinical data from a professional basketball club during the 2024-2025 season. Forty players (male and female) from four teams were included. Injury incidence was calculated as injuries per 1000 athlete-days. Injury burden was defined as total days lost. Distribution of injury burden was assessed using Lorenz curves, the Gini coefficient, and Pareto analysis. Multilevel modelling and clustering were applied as exploratory, hypothesis-generating analyses of player-level variability. Non-parametric tests (Mann-Whitney U and Kruskal-Wallis) and chi-square tests were used for group comparisons. A total of 50 injuries were recorded, accounting for 1369 days lost, corresponding to an overall incidence of 1.70 injuries per 1000 athlete-days (95% CI: 1.26-2.24). Injury burden showed a moderate-to-high degree of inequality (Gini = 0.61; 95% CI: 0.45-0.70). A relatively small proportion of injuries accounted for a substantial share of total time-loss: 5 injuries (10%) explained 50% of the burden, 18 injuries (36%) explained 80%, and 28 injuries (56%) explained 90%. No consistent relationship was observed between injury incidence and burden across teams. Injury burden in elite basketball appears to be unevenly distributed, with a limited number of injuries contributing substantially to total time-loss. These findings suggest that assessing the distribution of injury burden, rather than relying solely on incidence, may provide additional, preliminary insight into injury impact. However, given the observational design and limited sample size, these findings should be interpreted with caution.

Bioethics education has become established as an essential component for addressing the ethical challenges associated with biomedical development, biotechnology, and decision-making in the healthcare field. Although numerous studies have analyzed the teaching of bioethics among medical students and other health professions, empirical research on bioethics literacy in religious formation contexts remains limited. The objective of this study was to evaluate the level of bioethical knowledge (here operationalized as bioethics literacy) among Catholic seminarians in Colombia and to explore the psychometric properties of a questionnaire designed to measure bioethics literacy in this population. A cross-sectional observational study was conducted through the administration of a structured questionnaire consisting of 32 multiple-choice items with a single correct answer addressing philosophical foundations, personalist bioethics, bioethical principles, clinical bioethics, and issues related to biotechnology. A total of 216 complete questionnaires were analyzed using descriptive statistics and exploratory psychometric analyses, including item difficulty and discrimination, internal consistency, and exploratory factor analysis. The results showed a moderate overall level of bioethics literacy, with better performance in applied domains such as clinical bioethics and bioethical principles, and lower levels of correct responses in philosophical foundations and personalist bioethics. The questionnaire showed moderate internal consistency and a preliminary factorial structure, suggesting its usefulness as an exploratory tool for assessing bioethical knowledge in seminary educational contexts. These results highlight the importance of strengthening the integration between philosophical and theological education and the applied analysis of bioethical problems in seminary educational programs.