Hospital General Universitario de Alicante Doctor Balmis

The worldwide acceleration of digital transformation in healthcare underscores the need for professionals to continuously adapt and sustain robust digital health competence, shaped not only by individual characteristics and institutional environments but also by broader social, cultural, and geopolitical factors. This study aimed to identify distinct clusters of digital health competence among healthcare professionals across 19 diverse countries and regions, and to examine the factors influencing the development and distribution of these competence clusters. A cross-sectional international survey study was conducted between 2023 and 2024, using a validated survey instrument measuring digital health competence and its influencing factors. Data were collected from healthcare professionals in 19 countries and regions (n=6440; n=5945 used for this study), following a harmonised protocol with shared demographic templates and instruments. K-means cluster analysis was employed to derive digital competence profiles, with comparative analyses conducted to investigate associations between the identified clusters and individual characteristics (e.g., age, education, professional experience). Five distinct clusters of digital health competence were identified: (1) Beginners, (2) Developing Professionals, (3) Emerging Users, (4) Proficient Practitioners, and (5) Pioneers. Higher competence clusters (4 and 5) were associated with younger age, higher education, hospital-based work, and stronger perceived support from management, organisational structures, and colleagues. In contrast, lower-performing clusters reported limited digital engagement and minimal support. Perceived leadership influence, particularly managerial commitment to digital change, was a key differentiator across clusters. The findings demonstrate substantial variation in digital health competence across healthcare professionals internationally. Cluster-specific strategies, such as targeted upskilling, peer mentoring, and leadership engagement, are needed to address competence gaps. The results provide a foundation for policy development and workforce training frameworks aimed at strengthening digital readiness in global healthcare systems. Future research should explore longitudinal competence development and evaluate targeted interventions.

Migrant populations face a disproportionate risk of undiagnosed HIV and viral hepatitis, posing a major challenge to elimination goals. The HEPINMIGRA study evaluated the acceptability, feasibility, and effectiveness of an integrated community-based screening program for migrants in Alicante, Spain. Between March 2024 and February 2025, nine outreach campaigns were conducted in community settings with the support of intercultural mediators. Screening was performed using finger-prick dried blood spots. Among 535 attendees, 529 migrants were screened (acceptance rate 98.9%). Participants had a median age of 39 years, 56.1% were male, and 77.9% were of African origin. Seroprevalence was 1.1% for HIV (95% CI: 0.4-2.3%), 0.6% for HCV (95% CI: 0.1-1.6%), and 4.5% for HBsAg (95% CI: 2.9-6.6%). Although most individuals with positive results were successfully contacted and linked to care, treatment initiation rates were low. Community-based DBS screening was highly feasible and effective for case detection, but major gaps were identified in linkage to care and treatment initiation.

Breast reconstruction has become an integral component of the comprehensive management of patients undergoing mastectomy for breast cancer. Over the past decades, reconstructive techniques have evolved significantly, transitioning from simple pedicled flaps to sophisticated microsurgical procedures that aim to restore breast volume, symmetry, and patient quality of life. The objective of this review is to analyze the current therapeutic options for breast reconstruction in plastic and reconstructive surgery, emphasizing developments from 2020 to 2025, while also providing a historical overview of the principal reconstructive flaps, including their original descriptions and clinical evolution. Implant-based reconstruction and autologous tissue reconstruction using pedicled and free flaps are discussed in terms of indications, advantages, disadvantages, and associated complications. A comparative analysis of the most commonly used techniques is presented, highlighting patient selection criteria and surgical outcomes. Understanding the strengths and limitations of each reconstructive option allows the reconstructive surgeon to individualize treatment and optimize functional and aesthetic results.

Aortitis associated with giant cell arteritis (GCA) is a severe manifestation, potentially leading to aneurysms and aortic dissection. Tocilizumab (TCZ) has demonstrated efficacy in the treatment of GCA, both intravenously or subcutaneously administered. However, pivotal studies did not specifically evaluate aortic involvement, and no comparison of intravenous (IV) versus subcutaneous (SC) TCZ has been performed in patients with GCA-related aortitis. The objective of this study was to compare the effectiveness of TCZ according to the administration route in patients with GCA-associated aortitis under clinical practice conditions. This was a multicenter observational study including 196 patients diagnosed with GCA-associated aortitis by imaging and treated with TCZ. Patients were grouped by administration route: IV or SC. GCA was diagnosed following the 1990 American College of Rheumatology criteria, temporal artery biopsy, and/or vascular imaging. Aortitis was identified using 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan. Main outcomes included EULAR remission, clinical and imaging remission, absence of systemic inflammation, and glucocorticoid-sparing effect. Of 196 patients (148 women; mean age 69.8 ± SD 9.4 years), 110 received IV TCZ and 86 SC TCZ. Baseline clinical characteristics and markers of inflammation were comparable between groups. The glucocorticoid-sparing effect was similar. At 24-month follow-up, EULAR-defined remission was significantly more frequent in the SC group (83.3% vs 80.6%; P < 0.05). However, rates of imaging remission and absence of systemic inflammation were comparable between treatment arms. In this real-world cohort of GCA-associated aortitis, SC TCZ showed slightly greater effectiveness than IV TCZ in achieving EULAR-defined remission, whereas no significant differences were observed between both routes regarding imaging remission.