Luis El Khoury-Moreno

Background: The COVID-19 pandemic generated a notable emotional impact on the general population, yet its effects on incarcerated individuals have been far less explored, despite the particular vulnerabilities associated with prison environments. Objective: This study aimed to assess levels of anxiety and fear related to COVID-19 among incarcerated adults in Spain and identify sociodemographic and health-related factors associated with greater emotional distress. Methods: A cross-sectional study was conducted between May 2022 and February 2023 among 711 inmates from 3 Spanish prisons using a nonprobability convenience sampling strategy. Anxiety and fear related to COVID-19 were assessed using the Anxiety and Fear of COVID-19 Assessment Scale (AMICO)–Inmates scale, an adaptation of the original AMICO, developed for the general Spanish population, and subsequently validated for use among prison inmates. Descriptive analyses, bivariate comparisons, and categorical regression (CATREG) were performed to examine factors associated with the total AMICO score. Results: The mean AMICO score was 5.58 (SD 2.55), indicating high levels of anxiety and fear related to COVID-19. In the bivariate analyses, significant differences were observed according to sex, having children, sharing a cell, and the presence of chronic illness. The CATREG model explained 17.4% of the variance in AMICO scores ( R ² =0.174; P <.001). Female sex (β=0.214; P <.001), sharing a cell (β=0.112; P =.001), and chronic illness (β=0.086; P =.01) were independently associated with higher levels of anxiety and fear. Conclusions: Incarcerated individuals experienced high levels of anxiety and fear related to COVID-19. Women, inmates sharing a cell, and those with chronic illnesses appeared particularly vulnerable to emotional distress. These findings highlight the importance of incorporating targeted psychological support and mental health strategies into prison preparedness plans for future public health emergencies.

La vacunación ha sido una de las estrategias más efectivas de Salud Pública en España, con una evolución marcada desde campañas puntuales hasta la implementación de un calendario común de vacunación. Iniciado en 1975 con siete vacunas básicas, el calendario fue consolidándose a lo largo de los años hasta la aprobación, en 2018, de un calendario consensuado entre el Ministerio de Sanidad y las comunidades autónomas. Este modelo ha mantenido coberturas infantiles muy elevadas y ha contribuido a la erradicación de la viruela, la eliminación de la poliomielitis y la rubeola, y a mantener durante años la eliminación del sarampión. Su éxito se basa en una gobernanza interterritorial, criterios técnicos y éticos en la toma de decisiones y en la vigilancia epidemiológica. A pesar de los logros, persisten desafíos importantes: las brechas de cobertura entre dosis y grupos de edad; la variabilidad territorial y organizativa; la vacunación incompleta en parte de la población adulta; la reticencia vacunal y la sostenibilidad del calendario ante nuevas incorporaciones. La situación reciente del sarampión refuerza además la necesidad de cerrar bolsas de susceptibilidad y mantener una vigilancia epidemiológica y microbiológica sensible. El enfoque actual apunta a una inmunización a lo largo de toda la vida, incluyendo a adultos, embarazadas e inmunodeprimidos. Las tecnologías como las vacunas de ARNm y la vigilancia genómica ofrecen nuevas posibilidades. Asimismo, la pandemia de la COVID-19 mostró la importancia de una coordinación internacional sólida y de la participación comunitaria. De este modo, el calendario común es un pilar de cohesión sanitaria, y su futuro dependerá del consenso político, la innovación científica y la equidad.

Cancer remains a major global health challenge, requiring innovative diagnostic and therapeutic strategies. Cell culture models are essential tools in cancer research. While traditional two-dimensional (2D) cultures are widely used because of their accessibility and simplicity, they inadequately represent the tumor microenvironment. This review provides a molecular perspective on the biological differences between 2D and 3D cancer models, emphasizing extracellular matrix signaling, mechanotransduction, metabolic adaptation, tumor heterogeneity, and therapeutic resistance rather than a general comparison of culture systems. It discusses the limitations of 2D models and highlights the advantages of 3D systems, including spheroids and organoids, for more accurately recapitulating the tumor microenvironment and improving the predictive value of anticancer drug testing. This narrative review synthesizes current evidence on the roles of 2D and 3D cell culture methods in oncology. The literature was searched in PubMed, Google Scholar, and Web of Science from 2015 to 2026 using keywords including “2D cell culture,” “3D cell culture,” “spheroids,” “organoids,” and “cancer.” Studies were eligible for inclusion if they addressed cancer research using 2D or 3D cell culture models and provided relevant experimental, preclinical, or translational evidence, particularly regarding tumor microenvironment, extracellular matrix signaling, cellular interactions, therapeutic response, or molecular mechanisms. Studies unrelated to cancer or 2D/3D culture models, duplicate records, and publications lacking relevant primary data were excluded. Study selection was performed by screening titles and abstracts followed by full-text assessment according to the predefined eligibility criteria. Seminal studies were also included when considered relevant to the conceptual framework of the review. Findings were synthesized narratively without quantitative analysis. 2D cultures limit cell–cell and cell–extracellular matrix interactions, reducing the applicability of findings to in vivo conditions. In contrast, 3D cultures better reproduce oxygen and nutrient gradients and cellular interactions, providing a more realistic representation of the tumor microenvironment. Recent advances in 3D systems have improved predictive accuracy for drug screening and personalized medicine. Both 2D and 3D culture methods possess unique strengths and limitations. Used in complementary ways, they can improve the translation of in vitro findings to in vivo and clinical applications, accelerating progress in cancer research and therapeutic development.

The selection of an appropriate occlusal pattern for prosthodontic and orthodontic rehabilitation remains a subject of ongoing debate within the scientific literature. A potential resolution to this controversy involves investigating the prevalence of various dynamic occlusal schemes in the natural permanent dentition. This cross-sectional study was designed to assess the typical dynamic occlusion patterns observed in both younger and older populations and to examine whether these patterns are influenced by age. The study included a total of 207 participants possessing natural dentition with no prosthetic restorations. The age of the individuals ranged from 15 to 73 years. Dynamic occlusal patterns were recorded in all participants through a clinical assessment of lateral and protrusive mandibular excursions guided by the teeth. Dynamic occlusion was categorized into five types: (O1) bilateral canine guidance, (O2) unilateral canine guidance, (O3) group function, (O4) balanced occlusion, and a category labeled “other occlusions” (O5). The overall distribution of occlusal patterns was similar between male and female participants. “The aim of this study was to evaluate the prevalence of dynamic occlusal patterns in subjects with natural dentition and to determine whether these patterns are associated with age.” Because occlusal wear accumulates throughout life, it was hypothesized that the prevalence of canine-guided occlusion would decrease with age, while group function occlusion would become more frequent. The study group consisted of 207 patients, 112 women (54.1%) and 95 men (45.9%), ranging in age from 15 to 73 years (mean = 32.79 ± 13.87). Informed consent was first explained to the participants, who then signed a consent form. We performed Pearson’s chi-square test to determine the association between demographic variables (gender and/or age) on the dynamic occlusion models (DINs) described above. The association between age groups and occlusal patterns was assessed using Pearson’s chi-squared test. The strength of the association was estimated using Cramer’s V coefficient. A p-value < 0.05 was considered statistically significant. The analysis using Pearson’s chi-squared test did not show a statistically significant association between age groups and dynamic occlusion patterns (χ² = 15.17; df = 12; p = 0.232). The effect size, assessed using Cramer’s V coefficient, was 0.156, indicating a weak association between the two variables. Although descriptive differences were observed in the distribution of some occlusal patterns among the age groups, these differences did not reach statistical significance.

Early childhood caries (ECC) is a multifactorial chronic disease strongly influenced by feeding behaviors and oral hygiene practices. Co-sleeping is a common caregiving practice that may increase ECC risk by facilitating nocturnal feeding and limiting adequate nighttime oral care. This study aimed to evaluate the association between co-sleeping, related behavioral factors, and the presence and severity of ECC in children aged 1 to 6 years. A retrospective observational study was conducted using clinical and radiographic records from a pediatric dentistry clinic. The sample included 150 children aged 12 to 72 months. Parents completed a validated questionnaire on feeding practices, dietary habits, oral hygiene routines, sugar intake, and co-sleeping behaviors. ECC was assessed using the decayed, missing, and filled teeth index according to World Health Organization criteria. Logistic regression analyses were performed to identify associations between co-sleeping, behavioral variables, and ECC outcomes. Co-sleeping was reported in 18.7% of children. Co-sleeping children showed significantly higher mean decayed, missing, and filled teeth index scores than non–co-sleepers (7.14 vs 3.49). Co-sleeping was significantly associated with nighttime breastfeeding on demand, higher carbohydrate consumption, and inadequate oral hygiene practices ( P < .05). In most co-sleeping cases (89.3%), children fell asleep with milk remaining in the oral cavity. Co-sleeping was associated with an approximately 2-fold increase in ECC risk, and behaviors that may increase the risk and severity of ECC, particularly nocturnal feeding and insufficient oral hygiene. Targeted parental education on nighttime feeding and oral care practices may help reduce ECC risk. Prospective studies are warranted to confirm these findings.

Hotel housekeepers are exposed to high physical workload, repetitive tasks, time pressure, and limited social recognition. These occupational conditions may increase the risk of work-related health problems, particularly musculoskeletal disorders, and negatively affect functional capacity and long-term work sustainability. The objective of this systematic review was to synthesise the available evidence on the most prevalent work-related health conditions among hotel housekeepers and to examine their association with work-related risk factors. A systematic review was conducted in accordance with PRISMA guidelines. Electronic searches were performed in PubMed, Scopus, CINAHL, Embase, and Web of Science in November 2025 and updated on 18 March 2026. Eligible observational studies reporting the prevalence of work-related health conditions among hotel housekeepers were included. Study selection, data extraction, and quality appraisal (Joanna Briggs Institute tools) were conducted independently by reviewers. Findings were synthesised narratively and, where appropriate, pooled using random-effects meta-analysis with inverse-variance weighting, Freeman-Tukey double arcsine transformation, and restricted maximum likelihood estimation of between-study variance (τ²). Statistical heterogeneity was assessed using the I² statistic. Eight studies met the inclusion criteria and were included in the systematic review. All examined musculoskeletal disorders, consistently reporting high prevalence rates. Five of these studies contributed to the meta-analysis; pooled 12-month prevalence was highest for low back pain (73.0%; 95% CI: 42.9-90.7), followed by wrist/hand (54.7%; 95% CI: 27.7-79.2), shoulder (48.2%; 95% CI: 10.8-87.7), and neck (40.1%; 95% CI: 3.2-93.2). Several studies identified significant associations between musculoskeletal symptoms and labour exposures, including biomechanical load, repetitive movements, work organisation, adverse psychosocial conditions, and specific factors such as the number of beds made per shift, lack of training, and low job satisfaction. Substantial heterogeneity limited comparability across studies. Hotel housekeepers represent a particularly vulnerable occupational group with a high burden of work-related musculoskeletal disorders. The limited number of studies and their heterogeneity highlight the need for more robust, standardised epidemiological research. Preventive strategies addressing ergonomic design, workload management, and psychosocial risk factors are warranted to mitigate health risks and promote long-term occupational well-being in this workforce. The review protocol was registered in PROSPERO (CRD420261288316).

Mental disorders are a leading cause of morbidity worldwide, and healthcare professionals are particularly vulnerable due to occupational stressors, a vulnerability intensified during the coronavirus disease 2019 pandemic. This study assessed the prevalence of mental health disorders among hospital workers and examined changes in their perceived mental health during the pandemic. A descriptive cross-sectional study was conducted with 215 employees attending the Health Surveillance Service of Virgen Macarena University Hospital (Seville) between January 2019 and December 2022. Data were collected from occupational health records and a telephone survey, including the General Health Questionnaire (12 items) questionnaire. The prevalence of diagnosed mental health disorders was 7.0%, with mixed anxiety-depressive disorder being the most frequent. Most affected workers required short-term temporary incapacity due to common contingencies, and 36.7% required job adaptations, mainly involving task modifications. During the pandemic, 68.1% of workers reported a perceived worsening in mental health, which was more common among alcohol users. Among those receiving treatment, 70.8% required medication adjustments, and 31.2% reported increased analgesic use. Although prevalence rates were lower than expected, likely due to underdiagnosis and prioritization of coronavirus disease 2019-sensitive evaluations, the profile of affected workers was consistent with previous literature, predominantly women around 50 years old, often Assistant Nursing Care Technicians. These findings highlight the crucial role of occupational health services in early detection, monitoring, and support of healthcare professionals. Identification of alcohol use, psychiatric medication adjustments, and increased analgesic intake as risk factors emphasize the need for proactive interventions to sustain the healthcare workforce.

Background: In Spain, the number of patients anticoagulated with vitamin K antagonists (VKAs) is high. Among them, poor adherence is common, which may be justified by a low level of knowledge, and could affect their quality of life. We analyzed treatment adherence, health-related quality of life, and knowledge level about treatment, and evaluated the possible influence of these factors on patients’ time in the therapeutic range while also studying potential differences between patients under routine monitoring or self-monitoring. Methodology: A cross-sectional descriptive study was conducted using three validated and cross-culturally adapted questionnaires to study therapeutic adherence, health-related quality of life, and knowledge level about VKA treatment in a sample of anticoagulated patients. Additionally, it was assessed whether they were self-monitoring or not; the Rosendaal Time in Therapeutic Range (TTRr) was also administered for each patient at the time of recruitment. Descriptive analysis of all variables was performed, and a logistic regression model was constructed to evaluate the possible interaction of variables. Results: Ninety-eight patients participated and were selected sequentially from those attending the oral anticoagulation clinic at Hospital Universitario Virgen de la Victoria in Malaga. Of these, 39 were men and 59 were women. The mean age of these participants was 60.62 years (SD 11.67). Sixty-six were under conventional monitoring and thirty-two followed the self-monitoring program. The DecaMIRT had a mean score of 39.22 (SD 8.57), the SF-12 mean score was 31.73 (SD 6.21), and the knowledge questionnaire’s was 14.2 (SD 2.6). The mean TTRr value was 63.88 (SD 22.99). Self-monitored patients showed better results in DECAMirt and knowledge. Discussion: Overall, patients included in the sample presented satisfactory values in these three questionnaires, which seems to indicate that this was a treatment-compliant group with a correct quality of life, and adequately informed about their treatment. Conclusions: The work of nurses responsible for these aspects appears crucial in achieving these results. We aim to extend this study by focusing on groups with poorer results to design specific activities that allow for improvement in care and, as much as possible, homogenize outcomes. For this purpose, we intend to use all available tools, including those derived from the use of health-oriented artificial intelligence.

The Spanish Armed Forces require optimal oral health to ensure operability during international missions. In a cross-sectional study with a sample of 691 military personnel, 17.66% were classified as temporarily unfit (NAT), predominantly among enlisted ranks (21.7%). Employment status and smoking showed significant associations with NAT ( P < .000), while gender, age, and alcohol consumption were not significant factors. The decayed, missing filled teeth index, particularly its decayed component, was strongly related to NAT ( P = .000). Periodontal disease presence and the need for multiple dental treatments significantly increased NAT prevalence ( P < .000). Use of dental floss correlated with higher fitness, whereas mouthwash use was associated with increased NAT ( P < .05). These findings highlight the importance of prevention and risk factor control to maintain oral fitness and ensure military personnel effectiveness during deployments.

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services.