Instituto Nacional de la Salud

The increasing demand for sustainable substrates in agriculture and urban greening calls for alternatives to peat, whose extraction poses significant environmental risks. This study assesses the potential of olive pomace biochar (OB), wood biochar (WB), and green compost (GC), alone or in combination, to partially replace peat in growing media and improve substrate properties and plant development. Ten different substrates were formulated by substituting 10–20% of a commercial peat-based substrate with these organic amendments, using the commercial substrate alone as a control. The effects of such replacements were evaluated in the following experiments: a germination test conducted in Petri dishes using four forage species (Medicago polymorpha, Lolium perenne, Festuca arundinacea, and Lolium rigidum); and two parallel pot experiments lasting 100 days each (one with M. polymorpha and L. perenne, and another with young Olea Europaea var. Arbequina saplings). This study evaluated the impact on plant development, as well as the physical properties and composition of the substrates during the incubation process. Germination and survival of forage species were comparable or improved in most treatments, except those including 20% OB, which consistently reduced germination—likely due to high electrical conductivity (>10dS/m). In the pot experiments, substrate pH and total carbon content increased significantly with biochar addition, particularly with 20% WB, which doubled total C relative to control. Both forage species (Medicago polymorpha and Lolium perenne) and the olive saplings (Olea Europaea) exhibited normal growth, with no significant differences in biomass, water content, or physiological stress indicators when compared to the control group. Nutrient uptake was found to be stable across treatments, although magnesium levels were below sufficiency thresholds without triggering visible deficiency symptoms. Overall, combining compost and biochar—particularly WB and GC—proved to be a viable strategy to reduce peat use while maintaining substrate quality and supporting robust plant growth. This approach proved effective across the different plant varieties tested, including Medicago polymorpha, Lolium perenne, and young olive plants, which together encompass a wide spectrum of agronomic and horticultural applications as well as contrasting growth and nutrient requirements. Adverse effects on early plant development can be avoided by carefully selecting and characterizing biochars, with specific attention to salinity and C/N ratio. This finding is crucial for the successful large-scale implementation of sustainable alternatives to peat.

Background/Objectives: Problematic smartphone use is common among nursing students and has been linked to academic and psychosocial difficulties. This PROSPERO-registered systematic review (CRD42024559668) identified the instruments used to assess smartphone addiction in nursing students and, secondarily, pooled typical addiction levels using the Smartphone Addiction Scale–Short Version (SAS-SV; 10–60) and examined psychosocial correlates. Methods: Following PRISMA 2020, we searched PubMed, Scopus, Web of Science, CINAHL and ScienceDirect from 1 January 2014 to 9 May 2024. Eligible studies assessed problematic smartphone use in undergraduate nursing students with validated instruments, while development-only studies and pandemic-specific contexts were excluded. Methodological quality was appraised using the JBI checklist, and a random-effects meta-analysis was performed to estimate pooled scores and explore cross-study variability. Results: Fifty-three studies met inclusion; eleven contributed to the SAS-SV meta-analysis (N = 5586). The pooled mean score was 29.5 (95% CI 27.7–31.3), with very high heterogeneity (I2 = 98%). Sensitivity analyses yielded similar results, and no publication bias was detected. Across studies, higher smartphone addiction was correlated with elevated stress and anxiety, sleep disturbance, and poorer academic and clinical performance. Conclusions: Nursing students’ SAS-SV scores cluster around ~29/60, with substantial between-study variability. Higher addiction scores were consistently associated with stress, anxiety, poor sleep, and reduced academic and clinical performance. However, interpretation is limited by the cross-sectional nature of the included studies and the very high heterogeneity observed. Standardising measurement is essential, but equally important is developing targeted educational interventions to foster healthier smartphone habits in nursing education. These results may guide nursing educators and institutions to design programs that foster healthier digital habits and support students’ academic and clinical performance.

Eclampsia is a serious and potentially life-threatening complication of hypertensive disorders of pregnancy, characterized by the onset of new-onset seizures (tonic-clonic, focal, or multifocal) in the absence of other identifiable neurological causes. Most cases of eclampsia manifest postpartum, with the first 48 hours being the highest risk period. Recent literature has documented the emergence of atypical forms of eclampsia, in which seizures can occur in the absence of hypertension or proteinuria. The unpredictable nature of these cases makes timely diagnosis and management difficult. A 29-year-old female patient at approximately 40.6 weeks presented to the emergency department with prodromes of labor. An obstetric ultrasound was performed, and given the diagnosis of risk of loss of fetal well-being, an emergency segmental cesarean section was performed. Approximately four hours after the cesarean section, the patient presented two generalized tonic-clonic seizures. Anticonvulsant treatment was administered, a diagnosis of puerperal eclampsia was established, and her transfer to the Intensive Care Unit (ICU) was coordinated. The therapeutic plan in the ICU included an infusion of phenytoin as an anticonvulsant, antihypertensive management with alpha-methyldopa, hemodynamic support, correction of fluid and electrolyte imbalance, and empirical antibiotic therapy due to suspected urinary tract infection. Her subsequent evolution was favorable, remaining afebrile, hemodynamically stable, and without recurrence of seizures. The unusual presentation of puerperal eclampsia in the immediate postoperative period, in the initial absence of the classic diagnostic criteria of hypertension and proteinuria, is significant and of academic value. This case underscores the importance of maintaining a high level of clinical suspicion for eclampsia in the immediate postpartum period, even without prior criteria for preeclampsia. Early recognition and the timely use of magnesium sulfate are essential to reduce maternal morbidity and mortality.

Literature has consistently linked family elements as risk and/or protective factors in adolescence. Consequently, numerous family-focused prevention programs have been developed. In the context of selective and indicated prevention, the most structured actions take place within the municipal services. However, studies demonstrating the effectiveness of these interventions are scarce. Our aim was to explore the effectiveness of the Brief Intervention Program for addiction prevention in the family context (IBAF) to improve family protective dynamics. We used a quasi-experimental pretest-posttest design. The final sample consisted of 136 cases and 191 family members (64.9% women and 35.1% men). The dimensions of family functioning were measured with the self-reported Madrid Family Functioning scale. Results indicated a statistically significant increase post-intervention in family climate, family consensus, setting of rules and boundaries, coping patterns, and improvement in stress/anxiety. There were no significant differences based on the sex of the family members. The IBAF program shows promise in addressing the demand for structured interventions in family indicated prevention. Future research could build on these preliminary findings by testing the efficacy of the intervention using rigorous methodologies.

Malaria is the world’s most important vector-borne disease and is of particular importance in sub-Saharan Africa, with its large burden of morbidity and mortality. Advances in malaria control have re-awakened the old dream of its complete eradication. However, this possibility appears out of reach, leaving climate change of increasing importance, particularly in the densely populated African highlands. This chapter combines historical data for the burden of the disease of malaria in Ethiopia with a theory to develop a proposal to quantify the malaria burden attributable to climate change. The proposed malaria tax is based on the temperature-dependent changes in malaria risk and the sharing of annual costs related to malaria prevention and the residual malaria burden.

Introduccin: Actualmente, las investigaciones realizadas en Salud Global se han centrado en los Macroinfluencers (MacroInf) nicamente en el descubrimiento y adicin de herramientas y productos farmacolgicos, en detrimento del conocimiento sociolgico de la enfermedad/salud.Estudios recientes han demostrado que es necesario proponer una nueva agenda, con vistas a la globalizacin en el campo de la salud, ms que sino brinde solamente oportunidades para nuevas relaciones humanas.En Brasil, las regiones Norte y Nordeste son diferentes en estructuras geoeconmico-culturales de las otras regiones, y MacroInf es responsable del conocimiento global del tejido biopsicosocial de la enfermedad/salud.Objetivo: Presentar a los macroinfluencers una lgica contrahegemnica sobre nuevos segmentos de la salud global para cuatro enfermedades en dos macrorregiones brasileas.Metodologa: Se trata de una revisin integradora de la literatura, realizada de octubre/2023 a enero/2024, con base en

La responsabilidad del especialista en medicina crítica y terapia intensiva, se ha tornado en una obligación con un beneficio, la mayoría de las veces desconocido, ya que, es probable que en una gran parte de las ocasiones se obtengan resultados favorables en la evolución de los pacientes críticos, llegando a sacarlos de la unidad y hasta a sus domicilios, empero, que es lo que ocurre durante su manejo; inicialmente entablar un careo amigable y de confianza con los familiares, en forma posterior mantener una información que deba ser positiva o auspiciosa, sin embargo, todos sabemos que no siempre es así; es en este sentido, que mucha de las veces estamos sujetos a la respuesta o reacción de los familiares luego de recibir una información negativa; finalmente, si el desenlace es favorable, la calma viene de inmediato; no obstante, que pasa si ocurre lo contrario, es momento de buscar culpables?, habrá influido el accionar de otros colegas previamente? o en definitiva es algo que podía ocurrir en cualquier momento.La serenidad del médico intensivista debería ser un común denominador, muy por encima de las responsabilidades familiares, estrés desmedido por el exceso de trabajo diurno o nocturno y el riesgo por ganarse juicios de forma directa o indirecta; sin embargo, quien compensa todo esto? y así pueda ayudar, para que el intensivista trabaje apaciblemente, pienso que es algo utópico, ya que de un tiempo a esta parte, nuestra especialidad ha generado una imposición de cubrir espacios vacíos en las guardias médicas, dedicándonos día y noche a los pacientes críticos para mejorar resultados y disminuir la mortalidad1.El trabajo en equipo, con los médicos de atención primaria, enfermeras e intensivistas, demuestra que la información puede brindarse desde cualquier área, así que la coordinación y uniformidad de la misma es esencial, sobre todo en pacientes con problemas realmente críticos o terminales; por otro lado, según Wulff en 1995, citado en2, todos los componentes del cuidado de la salud deben sujetarse a tres principios éticos básicos: El principio samaritano: El deber de aliviar el sufrimiento y la muerte prematura causada por la enfermedad.El principio de autonomía: El deber de respetar la autonomía del individuo.El principio de justicia: El deber de luchar por una asignación justa de los recursos disponibles.
 El compromiso del intensivista en la información a los familiares, la atención al paciente sin perjuicios y la permanente preocupación por una evolución voluble, permiten poder retomar un elemento denominado como satisfacción familiar en la Unidad de Terapia Intensiva (UTI), empleando a la participación del familiar en las decisiones y a la satisfacción per se3,4. La toma de decisiones éticas generalmente no está asociada con un mayor agotamiento (Burnout) de los profesionales que trabajan en áreas críticas o de cuidado paliativo, esto se puede explicar por un desenvolvimiento interprofesional, que promueve un sentido de decisión compartida y empoderamiento basado en el equipo; a pesar de ello, en la actualidad es inevitable apuntar la responsabilidad de estas determinaciones hacia los intensivistas, por lo que, es correcto pensar en una distribución equitativa de las responsabilidades?5.Finalmente, el proceso de sacar adelante a un paciente crítico, depende del equipo multidisciplinario, de la reacción familiar, del estado basal del paciente y pienso que la resiliencia del profesional, hacen posible reflejar una responsabilidad compartida, sabiendo que es tácito, el empeño y trabajo denodado del intensivista.