Medicina Clínica y Social (https://www.medicinaclinicaysocial.org) is the first peer-reviewed scientific journal in the field of Medicine and Health Sciences published, as a contribution of the Social Anthropology Department, in the Santa Rosa del Aguaray Campus of the School of Medical Sciences of the National University of Asunción, Paraguay. Its primary purpose is the dissemination of the results of scientific works in the fields of Medicine, Health Sciences and Social Sciences applied to Health, in the form of high-quality scientific articles that follow scientific research methods and the concepts of ethics, providing scientific knowledge that contributes to the knowledge and solution of health problems.
Cátedra de Socioantropología, Facultad de Ciencias Médicas - Filial Santa Rosa del Aguaray (Universidad Nacional de Asunción)
Prevalence and Predictors of Anxiety Severity Among Health Sciences Students: A Cross-Sectional Study Using the GAD-7 Scale
Introduction: Anxiety symptoms were highly prevalent among university students, particularly those enrolled in healthcare programs, and were associated with significant academic and functional impairment. Objective: This study aimed to evaluate the prevalence and severity of anxiety symptoms using the GAD-7 scale and to identify associated factors among healthcare undergraduate students. Methodology: A cross-sectional study was conducted with 336 undergraduate students from eight healthcare programs at a Brazilian university. Data were collected through an online questionnaire including sociodemographic variables and the Generalized Anxiety Disorder-7 (GAD-7) scale. Ordinal logistic regression was performed to assess associations between anxiety severity (minimal, mild, moderate, and severe) and predictors such as age, sex, course type (Medicine vs. non-medical), and academic year. Results: The mean age was 22.0 years (SD = 4.6), and 70% of participants were female. Most students (75.3%) were enrolled in Medicine. The mean GAD-7 score was 8.0 (SD = 5.4). Anxiety severity was classified as minimal (27.4%), mild (38.1%), moderate (20.2%), and severe (14.3%), with 34.5% presenting moderate to severe anxiety. Female sex (OR = 2.3; p < 0.001) and enrollment in non-medical courses (OR = 3.2; p < 0.001) were significantly associated with greater anxiety severity. Increasing age was inversely associated with anxiety (p = 0.037). Conclusion: Anxiety symptoms were highly prevalent among healthcare students. Female sex and enrollment in non-medical programs were independent predictors of higher anxiety severity, while older age was associated with lower levels.
Copyright (c) 2026 Vivian Kaori Segawa, Julia Miwa Torata Nakano, Israel Kanaan Blaas, João Maurício Castaldelli-Maia https://creativecommons.org/licenses/by/4.0
Cardiovascular disease in women in Paraguay: Perception and preventive and risk behaviors
Introduction: In Paraguay, more than 30% of deaths in women are due to cardiovascular disease (CVD), although there is little information on women's perception of this risk. Objective: To describe the perception and preventive or risk behaviors for CVD in Paraguayan women, according to educational level. Methodology: This was an observational, descriptive, cross-sectional study with convenience sampling. Women who were personal and family contacts of outpatients at the National Hospital between January and March 2025 were invited to participate in the study. An online questionnaire was administered that included demographic data, perceptions of causes of death in the female population, and preventive or risk behaviors for CVD. Results: A total of 438 women between 17 and 77 years of age participated in the study; 123 with primary/secondary education and 325 with tertiary education. 31.7% identified CVD as the primary cause of death, with a higher incidence in the group with tertiary education (36.2% vs. 26%). 15.4 % were unaware that a woman can die from a heart attack. High blood pressure was the most common cardiovascular risk factor (31.5%). 27.1% had never had a cardiology checkup; 12.3% were unaware of their blood pressure levels, and 35.6% were unaware of their cholesterol levels. Only knowledge of cholesterol levels showed significant differences between educational levels. Conclusion: Cardiovascular risk perception among Paraguayan women is limited, and preventable risk behaviors persist. Educational strategies need to be strengthened to improve CVD prevention in this population.
Copyright (c) 2026 Dora Montiel–Jarolin, Margarita Samudio, Pamela Rolón, Magali Jarolin Montiel, Estela Torres https://creativecommons.org/licenses/by/4.0
Ambulatory care sensitive condition hospitalizations in three departments of Paraguay, 2019
Introduction: Avoidable hospitalizations for sensitive conditions in primary health care are a direct indicator of the amount of potentially preventable hospital activity, through timely and effective care at the first level of care. Objective: To determine the frequency of hospitalizations for Ambulatory Care Sensitive Conditions (CSCA) in 3 departments of Paraguay, year 2019. Methodology: The study was descriptive and cross-sectional, using the data recorded in the Hospital Discharge information system, which contains the records of hospitalizations of people in the health establishments. All those hospitalized in the three selected departments during the year 2019 were taken. The list of diagnoses of preventable hospitalizations was taken as a reference to those proposed by PAHO in the Compendium of impact indicators and intermediate results classified with the ICD-10. Results: Hospitalizations for a sensitive condition in primary care were 4,717 hospitalizations, which represent 20% of all hospitalizations. Within each department, no great differences are observed in terms of percentage. This indicates that 20% of hospitalizations could have been resolved at the first level of care with sufficient resolution capacity to adequately attend to health promotion, prevention and timely management of health conditions. Conclusion: There is a wide difference in hospitalizations of female and male patients. Female patients represented the majority, compared to men in all three departments. The department with the highest rate of hospitalization was Misiones.
Copyright (c) 2026 Juan Edgar Tullo Gomez, Laura Yohana Benítez Brizuela, Ángel Ricardo Rolón Ruiz Diaz https://creativecommons.org/licenses/by/4.0
Trend in seroprevalence of hepatitis B virus markers in donors from Paraguay from 2012 to 2023. A retrospective approach at the national level
Introduction: Hepatitis B virus infection has been declared a major public health problem by the World Health Organization. It is a potentially fatal disease. Preventing transmission through blood transfusions presents one of the greatest challenges; therefore, serological and molecular screening is performed to minimize risks. Objective: To evaluate the seroprevalence trend of hepatitis B virus markers in donors from Paraguay. Methodology: A retrospective cross-sectional descriptive study was carried out in which the seroprevalences of the central antigen (anti-HBc) and surface antigen (HBsAg) of the hepatitis B virus of adult donors registered in the National Blood Services System of Paraguay in the period 2012-2023 were analyzed. Results: From 2012 to 2023, 1.165.486 blood units were collected. The overall seroprevalence for the HBsAg marker was 0.33% (n=43,834), with a stable trend over time (r2=0.05; p=0.504). For the Anti-HBc antibody, the overall seroprevalence was 2.38% (n=27,707), with a downward trend (r2=0.80; p<0.001). Conclusion: Despite the stable and downward trends in reported seroprevalence in donors, the importance of centralizing data at the national level, the use of highly sensitive and specific detection tests, and the need to adopt preventive measures such as immunization in donors are highlighted.
Copyright (c) 2026 Nathalia Navarro, Margarita Samudio, Nelson Marqués Roa, Anibal Espínola Cano, Jimena Casco Cantero, Cecilia Gonzalez1 Vatteone, Pamela Mancuello, Leticia Rufinelli Arce, Amanda Carolina Molas https://creativecommons.org/licenses/by/4.0
Editorial transparency and post-publication traceability: Medicina Clínica y Social implements the Crossmark Policy
Publishing a scientific article does not end a journal’s editorial responsibility. Once an article enters the scholarly record, it may be cited, interpreted, reproduced, and incorporated into research, clinical practice, and policy decisions. Journals therefore have a continuing obligation to ensure that relevant changes in the status of a published article are communicated clearly, promptly, and in a way that readers can verify. Post-publication mechanisms, such as corrections, errata, expressions of concern, retractions, withdrawals, and new versions, should not be viewed as signs of editorial weakness. When managed transparently, they are part of the infrastructure of scientific integrity. Science progresses not only by generating new evidence but also by correcting, clarifying, and contextualizing what has already been published. Journals that document these processes openly help preserve the reliability and continuity of the scholarly record. As part of this commitment, Medicina Clínica y Social has implemented a Crossmark policy for updates, corrections, and retractions beginning with Volume 10. Participating articles now display the Crossmark button on both their HTML landing pages and PDF files. Crossmark, a service provided by Crossref, enables readers to verify whether the document they are viewing is the current version of record or whether a registered editorial update exists, such as a correction, erratum, expression of concern, retraction, withdrawal, or new version. This information is linked to the article’s DOI and remains accessible regardless of how the article is accessed. This implementation is consistent with international recommendations on publication ethics and editorial transparency promoted by organizations such as the Committee on Publication Ethics (COPE), the International Committee of Medical Journal Editors (ICMJE), and Crossref. In the context of Paraguayan scientific publishing, the visible and systematic use of Crossmark in both HTML and PDF formats represents a meaningful step toward strengthening the traceability, transparency, and accountability of the published record.
Copyright (c) 2026 Iván Barrios, Julio Torales, Gladys Estigarribia, João Maurício Castaldelli-Maia, Antonio Ventriglio, Israel González https://creativecommons.org/licenses/by/4.0
Body and Self-Worth: Association Between Body Dissatisfaction and Self-Esteem in Medical Students
Introduction: Body dissatisfaction is a relevant psychological factor in university students’ mental health, particularly in demanding fields such as Medicine. Its association with self-esteem has been widely documented, although evidence from Latin American contexts remains limited. Objective: To analyze the association between body dissatisfaction and self-esteem among medical students, and to explore differences according to sociodemographic and academic variables. Methodology: A cross-sectional study was conducted among medical students. Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES), and body dissatisfaction using the Body Shape Questionnaire–8C (BSQ-8C). Descriptive analyses, bivariate comparisons (Mann–Whitney U and Kruskal–Wallis tests), and adjusted linear regression were performed. Results: A significant negative association was found between body dissatisfaction and self-esteem. Body dissatisfaction was higher in women, while self-esteem showed borderline differences by sex. No significant differences in self-esteem were observed across academic years, although body dissatisfaction varied by year. In the multivariate model, body dissatisfaction and history of mental disorders were significantly associated with lower self-esteem, whereas BMI and sex were not significant predictors. Conclusion: Body dissatisfaction emerges as a central factor influencing self-esteem in medical students, with relevant clinical implications. These findings highlight the need for preventive strategies and early interventions targeting mental health in this population.
Copyright (c) 2026 Julio Torales, Antonio Ventriglio, João Mauricio Castaldelli-Maia, Tomás Caycho-Rodríguez, Gladys Estigarribia, Marcelo O’Higgins, Victoria Ocampo-Rojas, Camila Martínez-Villalba, Tamara Horvath-Mereles, Eva Giménez-Legal, Iván Barrios https://creativecommons.org/licenses/by/4.0
Uso de benzodiacepinas en niños, niñas y adolescentes: declaración del Departamento de Psiquiatría Pediátrica de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción (Paraguay)
El Departamento de Psiquiatría Pediátrica de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción (Paraguay) manifiesta su preocupación por el aumento del uso de benzodiacepinas (BZD) en niños, niñas y adolescentes. Estos fármacos (como diazepam, clonazepam, lorazepam o alprazolam) continúan prescribiéndose con frecuencia para el tratamiento de ansiedad, insomnio, agitación o síntomas conductuales asociados a trastornos del espectro del autismo y a discapacidad intelectual, a menudo en ausencia de supervisión especializada y sin un fundamento clínico suficientemente sólido. Esta tendencia resulta particularmente relevante en el contexto de la psiquiatría infantojuvenil, donde las decisiones terapéuticas deben considerar no solo la sintomatología actual, sino también el impacto potencial sobre el neurodesarrollo. En los últimos años, diversos estudios han documentado un crecimiento sostenido en la prescripción de agonistas de los receptores benzodiacepínicos en población joven, incluso en sistemas de salud con marcos regulatorios estrictos. En Hong Kong, un seguimiento poblacional de más de dos décadas evidenció un incremento progresivo en la administración de estos fármacos en menores de 24 años (1). De forma similar, en Francia, la investigación de Driot et al. identificó una asociación significativa entre vulnerabilidad social y mayor uso de BZD en población pediátrica (2), sugiriendo que factores estructurales y contextuales pueden influir de manera relevante en los patrones de prescripción. En Paraguay, la escasez de psiquiatras pediátricos ha llevado a que médicos de otras especialidades (particularmente psiquiatras de adultos y pediatras) asuman el desafío de abordar cuadros complejos de salud mental en población infantojuvenil. Si bien esta situación refleja un compromiso asistencial valioso, también pone de manifiesto la necesidad de contar con orientaciones claras que permitan reducir la variabilidad en la práctica clínica y evitar intervenciones potencialmente inapropiadas o de riesgo. En este contexto, la ausencia de lineamientos específicos puede favorecer el uso de estrategias farmacológicas de rápida acción, como las BZD, aun cuando su perfil beneficio-riesgo sea desfavorable en esta población. Por ello, la presente declaración tiene como objetivo ofrecer una orientación clínica clara, basada en evidencia, que reconozca las particularidades del contexto nacional, promueva la cooperación interdisciplinaria y establezca límites seguros para la prescripción de BZD en niños, niñas y adolescentes. Asimismo, busca contribuir al debate clínico y ético sobre el uso de psicofármacos en etapas tempranas del desarrollo, enfatizando la necesidad de priorizar intervenciones seguras, efectivas y sostenibles en el tiempo. El Departamento de Psiquiatría Pediátrica de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción agradece a la revista Medicina Clínica y Social por brindar el espacio editorial para la difusión de esta declaración en su versión íntegra, reconociendo la relevancia del tema para la práctica clínica, la formación médica y la salud pública.
Benzodiazepine use in children and adolescents: A statement from the Department of Child and Adolescent Psychiatry, School of Medical Sciences, National University of Asunción (Paraguay)
Copyright (c) 2026 Julio Torales, Viviana Riego, José Almirón, Oscar García, Pamela Figueredo, Martín Laterza, Mathías Cantero https://creativecommons.org/licenses/by/4.0
Implications of new diagnostic criteria for obesity on mental health comorbidities
A recent report published by The Lancet Diabetes & Endocrinology Commission entitled Definition and diagnostic criteria of clinical obesity (2025) represents a major conceptual shift in how obesity is defined and understood. Moving beyond the long-standing reliance on body mass index (BMI), the Commission proposes a framework that conceptualizes obesity as a multifactorial, chronic, and systemic disease, emphasizing its functional, metabolic, and organ-specific consequences rather than body size alone. This reconceptualization has profound implications not only for medical practice but also for mental health research and care. For decades, BMI has served as the primary diagnostic proxy for obesity despite well-documented limitations. BMI does not capture body composition, fat distribution, metabolic heterogeneity, or psychosocial burden. Individuals with elevated BMI may present preserved physical and mental functioning, whereas others with lower BMI values may experience marked psychological distress and functional impairment related to adiposity. Consequently, the exclusive use of BMI has often obscured clinically meaningful subgroups and contributed to both underdiagnosis and overmedicalization. By prioritizing disease impact over numerical thresholds, the concept of “clinical obesity” allows for a more nuanced understanding of obesity and its associated comorbidities. Importantly, this shift provides a valuable opportunity to integrate mental health more explicitly into obesity assessment and management, acknowledging that psychological distress may be both a consequence and a constituent dimension of the disease.
Copyright (c) 2026 Julio Torales, Marcelo O'Higgins, Tomás Caycho-Rodríguez, Antonio Ventriglio, João Mauricio Castaldelli-Maia, Iván Barrios https://creativecommons.org/licenses/by/4.0
Association of sexual orientation with current alcohol drinking and cigarette smoking in Colombian adults from the general population
Introduction: The available data present an inconsistent association between sexual orientation and alcohol or cigarette consumption in high-income countries. However, such studies are scarce in low- and middle-income countries. Objective: The study aimed to estimate the association between sexual orientation and current alcohol drinking and cigarette smoking among Colombian adults. Methodology: A secondary analysis of the National Survey on the Consumption of Psychoactive Substances was completed. Lay interviewers asked about sexual orientation, current alcohol drinking, and current cigarette smoking. Participants also completed the Patient Health Questionnaire-2 (PHQ-2) to assess depression risk. Results: 46,197 adults between 18 and 65 years (M=39.82, SD=13.83) participated; 59% were female. Lesbian/gay or bisexual (LGB) sexual orientation was related to current drinking alcohol (OR=1.63, 95%CI 1.37-1.94) and current cigarette smoking (OR=2.19, 95%CI 1.78-2.69). Conclusion: LGB sexual orientations were significantly related to current alcohol drinking and cigarette smoking. It is crucial to consider sexual orientation in alcohol and cigarette use prevention in Colombian adults.
Copyright (c) 2026 Adalberto Campo-Arias, Edwin Herazo, Carlos Arturo Cassiani-Miranda https://creativecommons.org/licenses/by/4.0
Seroprevalence and Risk Factors for Toxoplasmosis in Humans and Domestic Dogs from Central Department–Paraguay, 2023–2024
Introduction: Toxoplasmosis is a zoonosis caused by the protozoan Toxoplasma gondii, which infects warm-blooded animals, including humans. Environmental, behavioral, and sociodemographic factors influenced its transmission, requiring an integrated One Health approach. Objective: To determine the seroprevalence and risk factors associated with toxoplasmosis in humans and domestic dogs in the Central Department, Paraguay. Methodology:An analytical cross-sectional observational study with convenience sampling was conducted. In the first stage, IgG antibodies against T. gondii were measured in 133 people over 18 years and 52 dogs. In the second stage, humans were classified as seropositive or seronegative. Both groups completed a structured questionnaire to assess sociodemographic characteristics, hygienic-dietary habits, and knowledge about the parasitosis, identifying possible factors associated with infection. Results: Seroprevalence was 41.35% in humans and 40.38% in dogs. In humans, seropositivity increased significantly with age. Consumption of raw vegetables and low frequency of washing fruits and vegetables were identified as possible associated factors, although without statistical significance. Greater knowledge about toxoplasmosis was significantly associated with a lower probability of being seropositive (p = 0.0251). In dogs, being rescued and exclusive feeding with commercial feed were significantly associated with seropositivity (p = 0.034). Conclusion: The results highlighted the importance of strengthening health education and preventive measures in humans and domestic animals, considering the interaction among human, animal, and environmental health.
Copyright (c) 2026 Bioq Emilia Delvalle, Dra Cecilia González, Biologa Sady Britez, Dra Ivalena de Guillén, QA Laua Aria, Bioq Cynthia Bernal, Bioclin Alejandra Rojas , Dra María Eugenia Acosta https://creativecommons.org/licenses/by/4.0
In vitro antitumor effect of essential oil of leaves from ñandypa (Genipa americana L.) on human pancreatic carcinoma cell lines (MIA PaCa2)
Introduction: South American biodiversity offers a source of new therapeutic compounds. Cancer remains a major global health issue with high morbidity and mortality. ñandypa (Genipa americana L.), a medicinal plant with various reported properties, was tested for citotoxic activity of the essential oil from their leaves. Objective: to determine the in vitro antitumor effect of an essential oil derived from ñandypa on human pancreatic carcinoma cell lines (MIA PaCa2). Methodology:Essential oils from G. americana leaves were obtained via hydrodistillation, and their chemical composition was analyzed using Gas Chromatography-Flame Ionization Detection-Mass Spectrometry (GC-FID-MS). Pancreatic tumor cells and normal fibroblast cells were then tested for antitumor activity. The cells were treated with serial dilutions of the essential oil (0.1%, 0.5%, 1%, 1.5%, 5%, and 10%). Cell viability was measured using an MTT assay, with results read on a spectrophotometer at 570nm and 630nm. Results: GC-FID-MS analysis revealed the oil's primary components were alcohols (17.83%), aldehydes (9.58%), and esters (5.18%). Exposure to the oil for four hours resulted in a high rate of tumor cell mortality, with the effect being more pronounced at higher concentrations. Importantly, the oil was not found to be toxic to normal cells (MRC-5). Conclusion: The essential oil of Genipa americana L. exhibits significant, dose-dependent antitumor activity against human pancreatic carcinoma cells (MIA PaCa-2). Notably, it showed no toxicity toward normal human fibroblast cells (MRC-5). These findings, supported by the presence of bioactive compounds like BHT, ?-pinene, and ?-caryophyllene, suggest its potential as a selective therapeutic agent for pancreatic cancer.
Copyright (c) 2026 Eva Ruzena Montiel Fernández, Jorge L M. Ruíz https://creativecommons.org/licenses/by/4.0
Coverage, missed opportunities and reasons for not vaccinating children under 5 years of age in Paraguay
Introduction: Vaccine-preventable diseases remain one of the main causes of infant mortality, despite advances in immunization. Globally and in the Region of the Americas, vaccination coverage has decreased, falling below the recommended 95%. In Paraguay, low vaccination rates reflect barriers that compromise public health. Objective: To determine the coverage, vaccination opportunity, and the main reasons for non-vaccination in children under 5 years of age in Fernando de la Mora, Paraguay, in 2023. Methodology: Descriptive cross-sectional study carried out in 318 children selected by two-stage probability sampling. Vaccination coverage for BCG, pentavalent, and MMR were analyzed. Data were collected using questionnaires designed in Epi.Info 7.2, recording sociodemographic variables, vaccination status, coverage, opportunity, source of information on vaccines, reasons for non-vaccination, knowledge, attitudes, practices, and sources of information, analyzed with descriptive statistics such as frequency and percentages. Results: 53% of children had complete vaccination schedules. Vaccination coverage was high for BCG (98.43%) and low for MMR-2 (37.02%). Vaccination opportunity was complete for BCG, but decreased for MMR-1 (42.01%). The main reasons for not vaccinating were lack of knowledge about the schedule (38.9%), erroneous beliefs (21.48%) and lack of time on the part of parents (21.48%). 77% of that responsible received information about vaccination, with television, radio and print media being the most frequent sources (42.5%). Conclusion: Although the initial BCG and pentavalent coverage are high, there is still a marked decline in the continuity of the schedules and the opportunity to vaccinate. Lack of knowledge and erroneous beliefs are the main barriers identified, which highlights the need to strengthen educational and awareness-raising strategies to improve coverage.
Copyright (c) 2026 Ivonne Montiel, Andrea Ferloni, Silvia Gómez, Mónica Arellano, Miryam Soliz, Rossanna Prado, Claudia Barrios, Lorena Romero, Adriana Benítez, Lina Molina, Margarita Samudio, Águeda Cabello https://creativecommons.org/licenses/by/4.0
Nutritional Status of Patients with Chronic Kidney Disease undergoing Hemodialysis
Introduction: Chronic kidney disease (CKD) is a major public health issue, with a global prevalence of nearly 13% and a growing burden in Latin America and Paraguay. In advanced stages, hemodialysis becomes indispensable but may negatively affect nutritional status, leading to both undernutrition and overweight. Nutritional assessment through indicators such as body mass index (BMI) and sociodemographic data is essential to understand these alterations and guide intervention strategies. Objective: To evaluate the nutritional status of patients undergoing hemodialysis in a private center in Asunción, Paraguay, using anthropometric measurements and sociodemographic data. Methodology: Observational, descriptive, cross-sectional study in 120 adult hemodialysis patients. Sociodemographic information and anthropometric measurements (weight, height, BMI) were collected. Descriptive statistics and association tests were applied. Results: The mean age was 57.2 ± 13.2 years, with a male predominance (56.7%). Mean BMI was 27.3 ± 5.3 kg/m². A high prevalence of overweight (40.8%) and obesity (28.4%) was observed, with no cases of undernutrition. No significant differences in BMI were found between sexes or age groups, although variations in weight and height were noted. Conclusion: Hemodialysis patients showed a high prevalence of overweight and obesity, challenging the traditional perception of undernutrition in this population. These findings highlight the need for personalized nutritional interventions that address the complex nutritional profile of CKD patients
Copyright (c) 2025 Igor Ernesto Marcet Franco, Juan Daniel Acosta González, Claudia Patrícia Quintana, Edis Emanuel Ortigoza, Jazmín Barrios, Patricia Ríos Mujica https://creativecommons.org/licenses/by/4.0
Patients’ Knowledge and Habits Regarding Diabetic Foot Prevention Measures: Polyclinic of a Private University, Asunción, Paraguay, 2024
Introduction: Diabetes mellitus is a metabolic disorder associated with severe complications, including diabetic foot, a frequent cause of disability, hospitalization, and amputations. Despite the key role of healthcare personnel in patient education, knowledge and prevention gaps persist. Objective: To determine patients’ knowledge and habits regarding diabetic foot prevention measures at the Polyclinic of a Private University in Asunción, Paraguay, in 2024. Methodology: An observational, descriptive, and cross-sectional study was conducted among adult diabetic patients attending the Polyclinic. All consenting patients were included, while those with communication difficulties were excluded. A structured questionnaire was applied, and data were analyzed using descriptive statistics. Adequate knowledge or habits were defined as more than 50% of positive responses. Results: A total of 131 patients were included, predominantly male (70%), aged between 19 and 60 years. Overall, 64% demonstrated global knowledge of preventive measures. High awareness was observed regarding systemic complications of diabetes and the importance of specialized consultation, but lower knowledge was found concerning proper nail trimming and immediate action in case of injuries. Regarding habits, 79% of patients reported adequate preventive practices. Conclusion: Most patients showed favorable knowledge and habits for diabetic foot prevention, although specific areas for improvement were identified. These findings highlight the importance of continuous and targeted educational interventions to strengthen self-care practices.
Copyright (c) 2025 Igor Ernesto Marcet Franco, Clara Margarita Cáceres Bogado , María Belén Giménez Reyes, Ema Soledad Maidana Pont, Jazmín Barrios, Patricia Ríos Mujica https://creativecommons.org/licenses/by/4.0
Knowledge and Compliance of Mothers of Children Under 5 Years Regarding the Vaccination Schedule: San Expedito Settlement, Paraguay, 2024
Introduction: Vaccination schedules are evidence-based recommendations that allow populations to prevent communicable diseases in different age groups through immunization. Objective: To determine the knowledge and compliance with vaccination schedules among mothers of children under 5 years of age in the San Expedito settlement, San Lorenzo, Paraguay, 2024. Methodology: A descriptive, observational, non-experimental, quantitative study was conducted. The study population consisted of mothers of children under 5 years of age. The sample included 40 mothers selected through non-probabilistic sampling. Data were collected through interviews using a structured questionnaire. Information was tabulated in Microsoft Excel 2010 and analyzed with EpiInfo 7.2.0.1. Tables and descriptive graphs were generated. Results: Participants ranged in age from 18 to 36 years (mean 27). More than half of the children were infants. Half of the mothers had completed secondary education, a quarter were housewives, and over 10% worked as cashiers. More than half of the households reported incomes below the minimum wage. Regarding knowledge, more than half of the mothers lacked information about vaccination. However, more than half complied with the vaccination schedule according to the child’s age. Conclusion: Limited knowledge about vaccination was observed among mothers, although compliance with the vaccination schedule was above 50%. These findings highlight the need to strengthen education and awareness strategies in the community
Copyright (c) 2025 Fidelina Portillo Villalba, Arturo Silva Estigarribia, Anyelo David Romero Vallejos, María Isabel Rodríguez-Riveros https://creativecommons.org/licenses/by/4.0
Susceptibility of Healthcare Professionals to Vaccine-Preventable Diseases: Critical Care Unit, Hospital de Clínicas, San Lorenzo-Paraguay 2021
Introduction: Vaccination is a key strategy to prevent communicable diseases and reduce occupational risks among healthcare workers. In critical care units, it ensures not only individual protection but also patient safety. Objective: To determine susceptibility to vaccine-preventable diseases among healthcare professionals in the Critical Care Unit of Hospital de Clínicas, San Lorenzo, Paraguay, 2021. Methodology: An observational, descriptive, cross-sectional, quantitative study was conducted with a non-probabilistic sample of 90 professionals. Data were collected using a validated questionnaire and analyzed with EpiInfo 7.2. Susceptibility was assessed based on knowledge, vaccination coverage, institutional factors, and use of personal protective equipment. Results: Most participants were female (68%), aged 31–40 years (57%), and nurses (80%). A total of 97% correctly identified hepatitis B as viral in origin, but only 60% had a complete vaccination scheme. Regarding influenza, 99% recognized the annual schedule and 80% were immunized. Tdpa coverage reached 78%, while 97% had received the COVID-19 vaccine. Overall, 73% complied with the recommended vaccination scheme for healthcare workers. Institutionally, 96% reported that the hospital managed and required vaccination; 77% acknowledged provision of masks and 71% of gloves. In terms of susceptibility, 68% showed low risk as they had five or more complete vaccines. Conclusions: Healthcare workers showed high coverage and low susceptibility, though gaps remain in incomplete schemes and vaccination record availability. Strengthening institutional policies is recommended to ensure complete and updated immunization for all professionals
Copyright (c) 2025 Arturo Yvan Silva Estigarribia, María Isabel Rodríguez-Riveros https://creativecommons.org/licenses/by/4.0
Effect of an educational intervention on the level of knowledge, healthy lifestyle practices and metabolic control of patients in the diabetes mellitus 2 program of the department of Concepción, Paraguay: a single-blind experimental study
Introduction: Diabetes mellitus 2 is considered the new epidemic of the 21st century, its incidence and prevalence are increasing rapidly, and it is considered the second cause of death in Paraguay. Objective: To evaluate the effect of an educational intervention on the level of knowledge, healthy lifestyle practices, and metabolic control of patients in the Diabetes Mellitus 2 Program of the Department of Concepción. Methodology: Experimental, single-blind study in patients of the Diabetes Mellitus 2 Program of the Department of Concepción, year 2023. A simple random sampling was used, including 158 patients for the intervention group and 320 patients for the control group. The sample size was calculated with the Epidat 3.1 statistical program. For data collection, diabetic patients were summoned to the health services of their community and were collected through an interview in two periods, pre and post intervention, using two validated questionnaires: Diabetes knowledge Questionnaire 24 to measure the level of knowledge and for the healthy lifestyle the IMEVID instrument. In the intervention group an educational program was implemented for 3 months. Results: 480 patients participated, mean age 60.7 years ± 1, female sex control group 76.9% and intervention group 75.3%. Significant difference was found in the level of knowledge, lifestyle, metabolic control and adherence to treatment between the intervention and control group after three months of educational intervention (p <0.0001). Conclusion: the educational intervention significantly improved the level of knowledge, healthy lifestyle, metabolic control and adherence to treatment in patients with type 2 Diabetes Mellitus.
Copyright (c) 2025 Luciana Echeverría Acosta, Lorena Elizabeth Giménez, Miguela Ruiz Romero, Eva Natalia Giménez Legal, Ignacio Ortiz Galeano https://creativecommons.org/licenses/by/4.0
Patterns and Trends of Antimicrobial Resistance in Staphylococcus aureus Isolated in a Private Laboratory in Paraguay from 2020 to 2024
Introduction: Staphylococcus aureus, a pathogen of global concern, has the ability to develop antimicrobial resistance, a factor that demands continuous surveillance. Objective: The objective was to determine the patterns and trends of antimicrobial resistance of S. aureus isolated from purulent secretions of patients attended at a private laboratory in Paraguay between 2020 and 2024. Methodology: This was a descriptive, retrospective study that used data from the electronic database of a private laboratory for the statistical analysis of variables such as antimicrobial susceptibility of S. aureus, from purulent secretion culture requests between 2020 and 2024. Results: S. aureus was isolated in 28.6% (220/770). Of these, 56.8% (n=125) were resistant to methicillin. A total of 61.5% (n=88) of the isolates were from outpatients. A moderate correlation was observed between methicillin resistance and resistance to ciprofloxacin (R²=0.709) and erythromycin (R²=0.705). The isolates showed resistance to erythromycin (66%), ciprofloxacin (34%), clindamycin (32%), and gentamicin (19%), but were 100% susceptible to trimethoprim-sulfamethoxazole and vancomycin. Among the multidrug resistance patterns in methicillin-resistant S. aureus, co-resistance to erythromycin-ciprofloxacin (37.5%) stood out. Conclusion: The increasing resistance to erythromycin, ciprofloxacin, and clindamycin limits their use in empirical treatments and highlights the importance of improving epidemiological surveillance strategies
Copyright (c) 2025 Julio César Barrios Leiva, Margarita Samudio Acevedo, Rosa María Guillén Fretes, Norma Fariña, Ana Vega, Alicia Pereira Fariña, Fátima Rodríguez Acosta https://creativecommons.org/licenses/by/4.0
Gender gap in pharmacological reperfusion and outcomes of ST-elevation acute myocardial infarction: Paraguayan cohort 2019–2023.
Introduction: ST-elevation acute myocardial infarction (STEMI) is one of the leading causes of cardiovascular morbidity and mortality. Early reperfusion, mainly through fibrinolysis in developing countries, is essential to reduce complications and mortality. However, multiple international registries have documented gender inequities in access to reperfusion therapies, with greater delays and worse outcomes in women. In Paraguay, where fibrinolysis remains the most widely used strategy under the IAM Code, there had been no national analysis to assess these differences. Objective: To assess the gender gap in pharmacological reperfusion and in-hospital outcomes in patients with STEMI in Paraguay between 2019 and 2023. Methodology: Observational, retrospective, multicenter study based on the national registry of the IAM Code. Consecutive patients with acute coronary syndrome were included. Clinical characteristics, risk factors, reperfusion strategies, critical times, and in-hospital outcomes were analyzed using ?² and Mann–Whitney U tests, with significance set at p<0.05. Results: A total of 1,831 patients were included. Women were older (65.6 ± 12.4 vs. 60.3 ± 11.4 years; p<0.001) and had more hypertension, diabetes, and obesity, while smoking and alcohol consumption were more common in men. Fibrinolysis was performed in 64.1% of patients, less frequently in women than in men (61.1% vs. 66.2%; p=0.048). Critical times were longer in women: symptom-to-door (310 vs. 280 min), door-to-needle (50 vs. 40 min), and total ischemia (370 vs. 340 min; p<0.001). In-hospital mortality was higher in women (12.4% vs. 7.8%; p<0.001), as was heart failure (15.2% vs. 10.5%; p=0.01), while no significant sex differences were found in ventricular arrhythmias, stroke, or major bleeding. Conclusion: Women with STEMI in Paraguay have lower access to fibrinolysis, longer treatment delays, and worse in-hospital outcomes, confirming persistent gender inequities that require targeted health strategies.
Copyright (c) 2025 Dr. José Ortellado Maidana, Graciela González, Gabriel Gaona Figueredo, MSc. Dr. Ángel R. Rolón Ruiz Díaz, Marta Ferreira Gaona https://creativecommons.org/licenses/by/4.0
Difficult treatment of superinfected with pseudomonas aeruginosa verrucous leishmaniasis
Leishmaniasis is an endemic pathology produced by protozoans of the genus Leishmania, of which there are different species, which can affect skin, mucous membranes and /or viscera. We report the case of a 53-year-old male with erythematous violaceous plaque with verrucous borders, net limits in the thorax and back of 10 years of evolution, with a diagnosis of verrucous leishmaniasis, in whom systemic treatment was made with two different drugs and cryotherapy, with excellent result.
verrucous leishmaniasis; tegumentary leishmaniasis; therapeutic; cryotherapy
Zulema Alexandra Celeste Valiente Rebull
Copyright (c) 2025 Beatriz Di Martino, Celeste Valiente Rebull, Maria Lorena Re Dominguez, Lourdes Bolla, Mirtha Rodriguez Masi, Oilda Knopfelmacher https://creativecommons.org/licenses/by/4.0
Beyond the Rash: The Neuropsychiatric Impact of Measles and the Urgency of Prevention
Estimado editor: El pasado 7 de agosto de 2025, la Dirección General de Vigilancia de la Salud del Ministerio de Salud Pública de Paraguay emitió una alerta epidemiológica por sarampión, tras la confirmación de cuatro casos en el departamento de San Pedro, todos ellos sin antecedentes de vacunación documentada (1). El último brote con transmisión autóctona en el país se registró en 1998. Más recientemente, en 2023, se notificó un caso confirmado de fuente de infección desconocida, que no generó casos secundarios (1). Esta señal de alarma no es un hecho aislado: se enmarca en un contexto global de reemergencia del virus, favorecido por las brechas en la cobertura vacunal, la circulación internacional de personas y la complacencia que a veces se instala cuando una enfermedad ha sido declarada eliminada en un país. La rápida diseminación y el riesgo de brotes secundarios en comunidades vulnerables invitan a replantear una pregunta que, pese a décadas de evidencia científica, sigue sin recibir suficiente atención en el discurso público: ¿continuamos subestimando al sarampión como una enfermedad meramente febril y exantemática?
Copyright (c) 2025 Julio Torales, Gladys Estigarribia, Guillermo Sequera https://creativecommons.org/licenses/by/4.0
Evaluation of an educational intervention on arbovirus prevention at basic school no. 1973 "Costa Alegre" in the city of Coronel Oviedo, year 2024.
Introduction: Arbovirosis represent a major global public health concern due to their high prevalence and concentration in tropical and subtropical regions. They are mainly transmitted by Aedes aegypti and may cause clinical manifestations ranging from mild to severe. Objective: To evaluate the impact of an educational intervention on arbovirosis prevention at Costa Alegre School in Coronel Oviedo during 2024. Materials and Methodology: A longitudinal quasi-experimental study was conducted among fourth, fifth, and sixth-grade students between July and September 2024. A validated questionnaire developed by Vivas was applied, consisting of 10 knowledge questions (scored 0–1) and 6 skills questions assessed with a Likert scale. The Pan American Health Organization’s arbovirosis prevention booklet was used as educational material. Data were analyzed with Stata 16. Results: In the pretest, 27% of students demonstrated insufficient knowledge and 73% sufficient knowledge; in the post-test, sufficient knowledge increased to 99% and insufficient knowledge decreased to 1%. The McNemar test revealed a statistically significant increase in correct responses after the intervention (p < 0.001). Regarding skills, the Wilcoxon test indicated a moderate but significant improvement (p < 0.05), reflecting positive changes in preventive practices such as household cleaning, use of repellents, and control of water containers. Conclusion: The educational intervention significantly improved students’ knowledge and prevention skills, confirming its effectiveness as a school-based health promotion strategy. Replication in other educational and community settings is recommended to evaluate its long-term impact and applicability. Future studies should explore complementary strategies to strengthen learning and promote sustainable preventive practices
Copyright (c) 2025 Patricia Ríos Mujica, Catalina Elizabeth Segovia Barboza, Estigarribia G., Julieta Méndez, Guiomar Viveros de Cabello, Gloria González, Deisy Galeano https://creativecommons.org/licenses/by/4.0
Performance of medical faculty according to the perception of residents in core specialties at the Hospital Nacional: 2017-2018 period
Introduction: Competency-based medical education integrates knowledge, skills, and values, with the educator serving as a facilitator and role model. Performance evaluation is essential to improve educational quality, identify weaknesses, and adjust the teaching-learning process toward training high-level specialists. Objective: To evaluate residents' perception of the performance of faculty and teaching assistants in the core specialties of the National Hospital. Methodology: A cross-sectional descriptive study with cross-association was conducted, including faculty from Internal Medicine, Pediatrics, Gynecology/Obstetrics, and General Surgery during the 2017-2018 period. A validated UNAM questionnaire was used, with items on research methodology, computer literacy, responsibility, and provision of resources. Instrument reliability (Cronbach's alpha) ranged from 0.73 to 0.92. Comparisons were made using the Kruskal-Wallis test (p<0.05). Results: A total of 68 residents participated: 25 (36.7%) from Pediatrics, 18 (26.4%) from Gynecology/Obstetrics, 14 (20.5%) from Internal Medicine, and 11 (16.1%) from General Surgery. The overall median score was 78.8% (range: 41.6-99.9%), with no significant differences between specialties. The areas with the lowest scores were teaching methodology, informatics, and scientific research; the highest were responsibility and subject matter knowledge. Conclusions: Teaching performance was generally rated as good. However, deficiencies were observed in pedagogical methods, the use of technology in teaching, and participation in scientific research activities.
Copyright (c) 2026 Gladys Godoy, Rocio Raquel Rienzi Grassi, Margarita Samudio https://creativecommons.org/licenses/by/4.0
Discrimination capacity of the pirate test to detect vision disorders in preschool children
Introduction: The presence of amblyopia due to untreated vision disorders is a serious global problem, which prevalence will increase from 13 to 26% in 2060. Despite having stablished screening programs for early detection of vision disorders in schools and training teachers for the correct use of ophthalmic instruments. However, due to the high rate of false positive results, its validity decreased. This situation implies the need to find a simple, low cost and reproducible test that allows the detection of vision disorders without prior ophthalmological knowledge, which is the main reason why the Pirate Test was proposed. Objective: To determine the discrimination capacity of Pirate Test to detect vision disorders in preschool children in Piura city. Methodology: Diagnostic study test (“Pirate Test”) was applied to 447 preschoolers by their parents and then they were evaluated by an ophthalmologist who determined if they really had vision disorders and specify the validity of the applied Test through the analysis of its sensitivity (Se), specificity (Sp), and ROC curve using SPSS v16. Results: The Se and Sp values to detect refractive errors were 85.4% and 78.8%, whereas for amblyopia the values were 83% and 93.7%, respectively. Also, ROC curves in both cases reported good discrimination capacity to detect visual disorders and amblyopia. Conclusion: Pirate Test has good discrimination capacity to detect visual disorders and amblyopia in preschoolers. The cut-off point was less than 5 minutes, which implies that the possibility of having important visual disorders or amblyopia is high.
Copyright (c) 2025 Jenny Kam Lin Ku Lozano, Jorge Enrique Osada, Eduardo Maron Ku Lu, Maria Esther Lozano Ponce, Margarita Samudio https://creativecommons.org/licenses/by/4.0
Long-term effects of childhood abuse on mental health and delinquent behavior in adulthood: A systematic review
Introduction: This research examines the long-term effects of childhood abuse on adult mental health and delinquent behavior. Methods: A systematic review was conducted following PRISMA guidelines. From 500 studies initially identified, 100 duplicates were removed. Titles and abstracts were screened, excluding studies that did not meet inclusion criteria, such as non-systematic reviews or those lacking relevant data. Fifty studies underwent full-text review, and 25 met the final inclusion criteria. Results: A significant association was found between childhood abuse and adult mental health disorders, including anxiety, depression, and personality disorders. Moreover, childhood abuse was strongly linked to adult involvement in both violent and non-violent crimes. Conclusions: The evidence highlights the long-term impact of childhood abuse on mental health and delinquent behavior, emphasizing the need for focused research within specific national contexts.
Copyright (c) 2025 Thaís Puente-Ortega, Rodrigo Moreta-Herrera, Rocío Játiva, Julio Torales https://creativecommons.org/licenses/by/4.0
Acute myeloid leukemia with NPM1, IDH1 and IDH2 mutations in Paraguayan patients
Introduction: Acute myeloid leukemia (AML) arises from the clonal expansion of myeloid blasts in peripheral blood, bone marrow, or other tissues. Its etiology is associated with the development of genetic mutations. Identifying actionable mutations is clinically relevant for the diagnosis, prognosis, and treatment of AML. Objective: To identify and describe the mutation profile of the NPM1, IDH1, and IDH2 genes in Paraguayan patients diagnosed with AML. Methodology: A retrospective molecular epidemiological study was conducted on 32 AML patient samples harboring NPM1 mutations. Real-time PCR and Sanger sequencing were performed to detect genetic variants. Results: The most frequently detected NPM1 mutation was type A, identified in 94% (30/32) of cases. Additionally, IDH1 and IDH2 mutations were found in 40% (13/32) of cases, with the IDH2 R140Q variant being the most predominant. The most frequent co-occurrence of mutations was observed between NPM1 and IDH2. Conclusion: This study provides valuable insights into the mutational profile of NPM1, IDH1, and IDH2 in AML patients in Paraguay, highlighting the relevance of these markers for risk stratification and their potential benefit for targeted therapies.
Copyright (c) 2025 Lady Franco-Benegas, Maria Paz Mujica, Valerie Jolly, Victor Salinas, Jose Zarza, Diana Gonzalez, Denisse Di Tore, Laura Morel, Juan Jose Bogado, Monica Labrano, Samadi Leiva, José Manuel Ovando, Rodrigo Santacruz, Miguel Britez, Ana Ayala-Lugo https://creativecommons.org/licenses/by/4.0
Assessment of the risk of developing Type 2 Diabetes Mellitus through the Findrisc Test in Villa Mano Abierta, Central - Paraguay 2024
Introduction: The FINDRISC test is a simple, fast, inexpensive, and reliable tool to identify the risk of developing type 2 diabetes mellitus (DM2). Objective: To assess the risk of developing DM2 in the adult population of the social territory of the Mano Abierta Family Health Unit, Julián Augusto Saldívar district of the Central department of Paraguay in 2024. Methodology: A descriptive study with a cross-sectional analytical component and a population base with systematic random sampling was carried out. People between 18 and 64 years of age were included, who were present in the home at the time of the visit and signed the informed consent. Pregnant women and people diagnosed with type 1 or type 2 diabetes mellitus were excluded. A structured questionnaire containing general data and the items of the FINDRISC test was applied. Results: 396 people aged 18 to 64 years (median 40), 295 (74.5%) women, participated in the study. 15% (n: 61) and 25% (n: 99) of participants were at high and moderate risk, respectively. Factors associated with an increased risk of developing diabetes mellitus in 10 years were: female sex (p=0.0055; OR: 1.9 (1.2-3.2)); age group 55 to 64 years (p<0.0001); lower educational level (p=0.0005; OR: 2.5 (1.5-3.9)); obesity (p=0.0055; OR: 23.5 (9.6-56.9)); sedentary lifestyle (p=0.0001; OR: 2.2 (1.4-3.3)); high-risk waist circumference (p=0.0001); direct family history of DM2 (OR: 5.6 (3.6-8.8)); history of antihypertensive medication (p=0.0001; OR: 5 (5.6-16.1)) and high basal glycemia at any check-up (p=0.0001; OR: 14.4 (6.3-32.9)); but not the daily consumption of fruits and vegetables (p value=0.278; OR: 1.3 (0.8-2.1)). Conclusion: The risk of developing diabetes according to the FINDRISC test was elevated. All components of the test contributed significantly to the increased risk, except the consumption of fruits and vegetables.
Copyright (c) 2025 Luciana Echeverria Acosta, María Beatriz Ojeda, Lorena Beatriz Jara, Carlos Fabián Ayala, Nancy Carolina Cuevas, María Pastora Duarte, María Teresa Duarte, Laura María Riquelme, Liliana Soledad Ayala, Lorena Romero, Rosa Alicia Galeano, Margarita Samudio https://creativecommons.org/licenses/by/4.0
Microbiological quality of community water from tanks, wells, and sanitation companies
Introduction: Microbiologically unacceptable community water may pose a risk to the health of citizens. Objective: To evaluate the microbiological quality of community water samples in urban facilities. Methodology: A cross-sectional analytical study using non-probability convenience sampling. Water samples from 100 community facilities were processed from sources such as wells, tanks, and sanitation companies. Microbiological quality was assessed by counting mesophilic aerobic bacteria and determining the presence of pathogenic microorganisms. Isolated pathogens were identified, and their antibiotic susceptibility profiles were determined. The chi-square test was used for statistical analysis of the relationship between variables. Results: The most common type of water source was artesian wells in 50% of cases; the type of facility from which the most samples were collected was family homes in 40% of cases. Microbiological quality was acceptable in 56% of cases and unacceptable in 44%. The most common cause of unacceptability was the presence of pathogens. The most frequently isolated pathogens were Pseudomonas aeruginosa in 14% of samples and Klebsiella aerogenes in 8% of samples. The isolated pathogens demonstrated broad antibiotic susceptibility and were negative for extended-spectrum beta-lactamases and carbapenemases. Microbiological quality was statistically associated with the water source (p value 0.000). Conclusion: Although the majority of community water tested was microbiologically acceptable, the frequent isolation of pathogens in artesian wells requires corrective measures
drinking water, antibacterials, heterotrophic bacteria, sanitation
Copyright (c) 2025 Cristel Kennedy, Gladys Estigarribia , Luz Paredes, Ahabeli Espinola, Camila Mino, Maria Cano, Marian Cárdenas, Eliana Rodriguez, José Robadin https://creativecommons.org/licenses/by/4.0
Aesthetic Medicine and Public Health: a necessary reflection
This article offers a critical reflection on the need to integrate aesthetic medicine into the field of public health, moving beyond its traditional perception as merely cosmetic. It argues that this discipline can significantly contribute to physical, mental, and social well-being, particularly among vulnerable populations. Key aspects discussed include improvements in quality of life, the reduction of aesthetic inequalities, the positive impact on mental health, and the preventive role of certain procedures. The recent enactment of Law No. 7344/2024 in Paraguay, which regulates the professional practice of aesthetic medicine, is highlighted as a milestone in advancing its professionalization and health oversight. The article concludes that incorporating aesthetic medicine into public policy can help promote more inclusive and human-centered health systems.
Copyright (c) 2026 Carlos Miguel Rios-González https://creativecommons.org/licenses/by/4.0
Barriers to Healthcare Access for Indigenous Older Women: A Qualitative Study in Zapopan, Jalisco
Introduction: Research on older indigenous women in urban settings was limited. This group faces cumulative disadvantages that constrain access to health care. Objective: To identify the barriers to health care access faced by older indigenous women in urban peripheries. Methodology: A qualitative narrative study was conducted with six indigenous women aged 58 to 83 living in an urban settlement in Zapopan, Jalisco. Semi-structured interviews were conducted, and a deductive thematic analysis was performed based on barriers to access and a comparison between rural and urban areas. Results: In places of origin, services were intermittent, and infrastructure was insufficient. In the city, greater availability was accompanied by confusing procedures, restrictive institutional timelines, and administrative costs, combined with informal incomes and a lack of financial protection. Distance to medical services, transportation, and dependence on family members made access to health services difficult. Cultural and communication barriers persisted due to the predominance of technical Spanish, as well as implicit literacy requirements. Many participants interpreted pain and limitations as part of aging and prioritized care only when conditions worsened, reducing care for chronic diseases. Conclusion: Barriers did not disappear with urban migration; they were reconfigured. The combination of procedures, institutional timelines, and transportation conditions resulted in differentiated access and fragmented treatments. The need for effective portability of the right to health was indicated.
Copyright (c) 2026 Hernández-Delgado, YJ, Pelcastre-Villafuerte, B.E. https://creativecommons.org/licenses/by/4.0