Janeth Elizabeth Orellana-Zárate

Digital triage has emerged as an increasingly relevant strategy for reorganizing access to primary care by allowing patients to communicate symptoms and healthcare needs through digital platforms before direct clinical assessment. This study analyzed its impact on accessibility, continuity of care, and healthcare service utilization through an integrative review and comparative health-services analysis. Evidence from observational studies, systematic reviews, mixed-method investigations, and evaluations of digital and telephone triage models was examined. The findings showed that digital triage can improve flexibility and timeliness of access, although utilization varies according to demographic characteristics, digital literacy, and system design. Evidence also demonstrated that reductions in face-to-face consultations may be accompanied by increases in telephone or digital contacts, indicating a redistribution rather than a consistent reduction in healthcare demand. Continuity of care was more likely to be preserved when digital triage was integrated with the patient’s usual primary care team and electronic health record. Differences in access among population groups highlighted the importance of maintaining alternative pathways for patients at risk of digital exclusion. Overall, digital triage should be considered a complex organizational intervention whose effectiveness depends on clinical integration, equity, continuity, patient safety, and appropriate escalation mechanisms. Its principal contribution may lie in improving the prioritization and distribution of care rather than simply reducing the number of conventional consultations.

The gut microbiota has emerged as a fundamental regulator of systemic human physiology, extending its influence far beyond the gastrointestinal tract. Recent advances in microbiome research have demonstrated that intestinal microorganisms participate actively in metabolic regulation, immune homeostasis, neuroimmune communication, inflammatory signaling, and chronic disease progression. The present review aimed to analyze current scientific evidence regarding the relationship between gut microbiota and systemic diseases, with special emphasis on immunological and neurological implications beyond digestive pathology. A structured narrative review methodology based on the Scientific Method was employed through analysis of peer-reviewed literature indexed in internationally recognized scientific databases including PubMed, Scopus, ScienceDirect, and SpringerLink. The review integrated multidisciplinary evidence involving gastroenterology, neurology, immunology, microbiology, metabolism, and translational medicine. The selected studies evaluated mechanisms associated with intestinal dysbiosis, systemic inflammation, gut–brain axis signaling, immune dysregulation, microbial metabolites, and microbiota-targeted therapeutic strategies. The analyzed evidence demonstrated that alterations in gut microbial diversity are strongly associated with chronic inflammatory diseases, obesity, type 2 diabetes mellitus, cardiovascular disease, autoimmune disorders, neurodegenerative pathology, and psychiatric conditions. Key mechanisms identified included increased intestinal permeability, chronic low-grade inflammation, abnormal immune activation, altered short-chain fatty acid production, and neuroimmune dysregulation mediated through the gut–brain axis. Furthermore, microbiota-targeted interventions such as probiotics, prebiotics, dietary modulation, postbiotics, and fecal microbiota transplantation demonstrated promising therapeutic potential in restoring microbial balance and reducing inflammatory activity.

Burnout syndrome, chronic fatigue, and mental health disorders have become major occupational health concerns among healthcare professionals worldwide. The increasing complexity of healthcare systems, growing workloads, staffing shortages, administrative pressures, and exposure to emotionally demanding clinical environments have contributed to elevated levels of psychological distress across healthcare settings. This review aimed to analyze current scientific evidence regarding the determinants, manifestations, consequences, and intervention strategies associated with burnout, chronic fatigue, and mental health outcomes among healthcare workers from an international perspective, with particular attention to findings reported in Mexico, Colombia, and Ecuador. A structured literature review was conducted using scientific publications retrieved from major biomedical and multidisciplinary databases. The evidence consistently identified emotional exhaustion, sleep disturbances, anxiety symptoms, depressive manifestations, psychological distress, and chronic fatigue as the most frequently reported outcomes. Excessive workload, prolonged working hours, staffing shortages, administrative burden, and insufficient organizational support emerged as the principal occupational determinants associated with adverse psychological outcomes. Findings from Latin America closely paralleled international trends, demonstrating similar occupational challenges across diverse healthcare systems. The review also revealed that organizational interventions, including workload optimization, leadership development, institutional support programs, and access to mental health services, were generally more effective than isolated individual-focused approaches. These findings highlight the importance of comprehensive occupational health strategies aimed at protecting healthcare worker well-being, improving workforce sustainability, and enhancing healthcare quality. Continued efforts to address organizational stressors and promote supportive work environments are essential for strengthening the resilience of healthcare professionals and healthcare systems worldwide.

The enteric nervous system (ENS), commonly referred to as the “second brain,” has emerged as a key integrative network in clinical medicine. This review analyzes its role beyond gastrointestinal physiology, emphasizing its involvement in neurological, nephrological, and urological conditions through interconnected mechanisms such as the gut–brain, gut–kidney, and gut–bladder axes. A structured analysis of current scientific literature was conducted to identify the main pathways linking ENS dysfunction with multisystem disease, including microbiota dysbiosis, neuroimmune activation, autonomic imbalance, epithelial barrier disruption, and visceral hypersensitivity. The findings demonstrate that while gastrointestinal manifestations remain predominant, ENS-related alterations are strongly associated with systemic inflammation, neurological symptoms, and urinary dysfunction. Additionally, emerging therapeutic strategies highlight the importance of integrative approaches, including dietary interventions, microbiota modulation, neuromodulation, and anti-inflammatory treatments. These results support the concept of the ENS as a central regulator in multisystem physiology and reinforce the need for interdisciplinary clinical reasoning. Understanding the ENS from a systems-based perspective provides valuable insights for improving diagnosis, treatment, and medical education in the context of complex and chronic diseases.