Artículos Medicina y Ciencias de la Salud

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Virtual reality training is associated with high satisfaction and self-perceived surgical confidence in anterior cruciate ligament reconstruction: Experience from an orthopedic residency pilot study
(2026) Guiloff, Rodrigo; Pino, Ernesto; Armijo-Rivera, Soledad; Cabrolier, Jorge; Schulmeyer, Juan; Radkievich, Ruben; Vaisman, Alex; Rafael, Calvo; Figueroa, David
Introduction/objective: Virtual reality (VR) is increasingly used in surgical education by enabling risk-free, immersive, and independent training. As orthopedic surgery residency programs increasingly integrate VR-based simulation, evidence regarding trainee satisfaction and self-perceived confidence remains scarce. This study aims to evaluate orthopedic surgery residents' satisfaction and self-perceived confidence following VR-based simulation training (VRT) in anterior cruciate ligament reconstruction (ACLR). The hypothesis is that VRT would result in high satisfaction and improve confidence in performing the procedure. Methods: A cross-sectional pilot study was conducted on 12 orthopedic surgery residents (4 per postgraduate year) from a three-year residency program. Residents with prior VR-based ACLR simulation experience were excluded. Each participant completed two VRT sessions using PrecisionOS software on the Oculus Quest 2 headset, practicing the inside-out ACLR technique. Pre- and post-training assessments included a validated five-point Likert scale and the net promoter score (NPS) to measure satisfaction and self-perceived confidence. Results: Eleven residents (91.7%) completed the study. Overall satisfaction with VRT was high, with most participants rating the experience as "agree" or "strongly agree" across all learning dimensions. The second session showed higher median satisfaction scores in five of six items. Participants valued VR training to improve procedural understanding, facilitate content application, and reinforce skills through immersive, tutor-independent learning. Overall, all sections achieved positive NPS values exceeding 40 (41-73), highlighting that VR training was an engaging way to learn. Third-year residents reported the greatest improvement regarding self-perceived confidence in executing the procedure, particularly to perform as the primary surgeon. First- and second-year residents showed increased confidence in assisting the procedure. Conclusion: This pilot study suggests that VR-based ACLR training is well accepted by orthopedic surgery residents and provides a highly satisfactory and immersive learning experience. Residents reported improved understanding of procedural steps and increased self-perceived confidence, with senior residents benefiting most in relation to the primary surgeon role and junior residents reporting greater confidence in assisting in the procedure. These findings support the feasibility and acceptability of VR simulation as a self-directed educational tool within orthopedic residency training programs
Lateral extra-articular tenodesis reduces graft failure without affecting functional outcomes after revision anterior cruciate ligament reconstruction: A retrospective comparative study with 6-year follow-up
(2026) Gonzalez, Waldo; Isla, Jorge; Sandoval , Alfredo; Figueroa, Francisco; Itriago, Minerva; Figueroa, David
Introduction: Revision anterior cruciate ligament reconstruction (ACLR) is associated with a substantially higher risk of anterior cruciate ligament (ACL) graft failure than primary ACLR. Lateral extra-articular tenodesis (LET) has gained increasing attention as an adjunctive procedure to enhance rotatory stability and potentially reduce the rate of ACL graft failure. The purpose of this study was to compare clinical and functional outcomes between patients undergoing isolated revision ACLR and those undergoing revision ACLR with concomitant LET. We hypothesized that the addition of LET would reduce the incidence of ACL graft failure without compromising functional outcomes or return-to-sport rates. Methods: This retrospective cohort study included skeletally mature patients who underwent first-time revision ACLR with a minimum follow-up of four years. Patients were divided into two groups according to surgical technique: isolated revision ACLR (n = 58) and revision ACLR with LET (n = 65). ACL graft failure was defined as clinically confirmed graft rupture based on a positive pivot-shift or Lachman test, magnetic resonance imaging, or the need for further revision ACLR. Demographic characteristics, surgical details, and patient-reported outcomes (International Knee Documentation Committee [IKDC] and Tegner activity scale) were compared between groups. Results: A total of 123 patients were analyzed (mean age: 27.1 ± 8.0 years) with a mean follow-up of 6.0 years (range: 4.5-7.3 years). Functional outcomes were comparable between groups (IKDC score: 80.4 ± 9.2 vs 84.1 ± 8.8; p = 0.86; Tegner score: 6.6 ± 1.3 vs 6.7 ± 1.2; p = 0.92). ACL graft failure occurred in 11 patients (18.3%) in the isolated revision ACLR group and in 2 patients (3.3%) in the revision ACLR with LET group (p = 0.03; odds ratio: 0.15; 95% confidence interval: 0.03-0.72). Sixty percent of all patients (74/123) returned to sport, including 50 (40.6%) who reached their preinjury level, with no statistically significant differences between groups (p = 0.41). Conclusion: The addition of an LET to revision ACLR significantly reduced the rate of ACL graft failure without adversely affecting functional recovery or return-to-sport rates. This procedure may serve as a valuable adjunct for selected high-risk patients undergoing revision ACLR
Dynamic knee valgus as a predictor of graft rerupture after anterior cruciate ligament reconstruction: Influence of sex and graft type
(2026) Gonzalez, Waldo; Riquelme, Juan; Barba, Diego; Erskine, Daniela; Venegas, Rodrigo; Calvo, Rafael; Figueroa, David
Introduction: Dynamic knee valgus has been identified as a potential risk factor for anterior cruciate ligament (ACL) injury, but its role in predicting graft failure or contralateral rupture after anterior cruciate ligament reconstruction (ACLR) remains unclear. The purpose of this study was to evaluate dynamic valgus (DV) as a predictor of graft re-rupture and contralateral ACL injury following ACLR, and to explore whether graft type influences this association. Methods: Prospective cohort study was conducted patients who underwent primary ACLR between 2020 and 2024. Patients with multiligament injuries, osteotomies, or revision surgeries were excluded. DV was measured during a standardized return-to-sport (RTS) drop jump test. Logistic regression was performed to assess associations with graft rerupture and contralateral ACL injury, adjusting for age, sex, body mass index (BMI), and graft type. Receiver operating characteristic (ROC) analysis was used to evaluated discriminative ability. Results: A total of 137 patients completed follow-up at a mean of 3.0 ± 1.2 years. Most patients were male (75.9%), with a mean age of 26.7 years. Ten patients (7.3%) sustained a graft re-rupture and nine (6.6%) a contralateral rupture. The DV was an independent predictor of graft rerupture (adjusted odds ratio [aOR]: 1.07; 95% confidence interval [CI]: 1.001-1.15). In sex-stratified analyses, this association was statistically significant only among men (aOR: 1.13; 95% CI: 1.02-1.24), with an area under the curve (AUC) of 0.76. A threshold between 18° and 20° yielded a balanced sensitivity and specificity of 71% and 73%, respectively. No statistically significant differences in DV were observed across graft types. Conclusion: DV is an independent predictor of graft rerupture after ACLR, particularly among men, where valgus angles above 18-20° markedly increase the risk of failure. These findings support the integration of DV assessment into postoperative follow-up to identify high-risk patients and to inform graft selection and rehabilitation strategies. Level of evidence: III
Impact of body mass index on robotic-assisted total knee arthroplasty outcomes: A retrospective cohort analysis
(2025) Gonzalez, Waldo; Calvo, Rafael; Figueroa, David; Isla, Jorge; Landea, Daniela; Tapia, Camila
Introduction: Obesity is a growing global health concern and a known risk factor in total knee arthroplasty (TKA). With an increasing number of obese patients requiring TKA, it is essential to understand how obesity influences clinical outcomes and complication rates. The objective of this study is to investigate the impact of obesity on clinical outcomes and complications in patients undergoing robotic-assisted TKA (RA-TKA). Methods: A retrospective cohort study was conducted on 216 patients aged ≥18 years who underwent RA-TKA between 2019 and 2023, with a minimum postoperative follow-up of one year. Patients were stratified into three body mass index (BMI) categories: <25, 25-29, and ≥30 kg/m2. Demographic, intraoperative, and postoperative variables-including tourniquet use and time, implant type, hospital stay, and complications-were compared. Statistical analysis was performed (p < 0.05). Results: Two hundred sixteen patients (91.5% follow-up rate) were evaluated at a mean of 34 months, postoperatively. No statistically significantly difference was found among the BMI groups in terms of age, sex, use of tourniquet, hospital stay, or use of stem implants. A statistically significant difference was observed only in the group of BMI <25 kg/m2 regarding arthrofibrosis. When patients were grouped as a BMI <35 vs a BMI ≥ 35 kg/m2, a higher complication rate was noted in the ≥35 kg/m2 group (18.2% versus 7.2%), though the difference was not statistically significant (p = 0.09). Conclusions: This study found that the difference was not statistically significant in the overall rate of postoperative complications among patients with obesity undergoing RA-TKA. However, a nonsignificant trend toward a higher complication rate was observed in patients with severe obesity (BMI ≥35 kg/m2). Interestingly, a statistically significant increase in arthrofibrosis was found in patients with BMI <25 kg/m2, a finding that contrasts with the current literature. Level of evidence: Level III.
Return to sports and recreational activities after patellofemoral arthroplasty: A systematic review
(2025) Arteaga, José; Poblete, Eduardo; Martin, Fernando; Domecq, Gabriel; Figueroa, David
Importance: Patellofemoral arthroplasty (PFA) is an established treatment for isolated patellofemoral osteoarthritis. However, evidence regarding postoperative activity levels and return to sport (RTS) remains limited. Objective: The objective of this study was to evaluate RTS and recreational activity rates following PFA, identify factors influencing these outcomes, and report associated complications. Evidence review: A systematic search was conducted in June 2024 across PubMed, EMBASE, ScienceDirect, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms included variations of “patellofemoral arthroplasty,” “physical activity,” and “return to sport.” Studies were included if they reported RTS outcomes following PFA. Studies lacking RTS data or isolated PFA results were excluded. From 492 records, 7 studies met the inclusion criteria. Findings: Seven studies (2 prospective and 5 retrospective) comprising 265 patients (281 knees; 64.6% women; mean age: 48.9 years) were included, with a mean follow-up of up to 5.3 years. RTS definitions varied, with reported rates ranging from 64.7% to 91%. Low-impact sports were more commonly resumed, and 58.6% of patients returned to sport within six months. Among those who returned, 74.8% reached or exceeded their preoperative activity level. Postoperative pain improved (visual analog scale scores decreased from 6.3 to 2.7), although up to 38.6% of patients reported pain limiting activity. Conversion to total knee arthroplasty occurred in 6.3% to 13% of cases, and reoperation rates ranged from 10.4% to 25%. Limitations included inconsistent RTS definitions, heterogeneous outcome reporting, and use of non-standardized questionnaires. Conclusions: RTS and recreational activity after PFA can be resumed by most patients, especially low-impact activities. Pain management should be actively addressed. High-quality studies with standardized RTS definitions are needed to evaluate the long-term impact of activity on implant survival. Relevance: RTS after PFA is safe and achievable. A personalized approach is essential to optimize RTS and manage patient expectations. Evidence level: III.
Return-to-sport tests: Do they reduce risk of re-rupture after anterior cruciate ligament reconstruction?
(2026) Figueroa, David; Gonzalez, Waldo; Landea, Daniela; Tapia, Camila; Erskine, Daniela
Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. Despite the effectiveness of reconstruction, re-rupture rates of up to 15 % have been reported. Static and dynamic test of strength and movement control have been used to determine when return to sports (RTS) is appropriate. Objective: To determine whether successfully passing return to sport (RTS) tests reduces the re-rupture rate. Methods: Retrospective cohort study. Patients who underwent ACL reconstruction (ACLR) from June 2018 to May 2023, and who performed RTS tests after rehabilitation, were analyzed. Patients who, in addition to ACLR, underwent extra-articular tenodesis, osteotomy, or multiligament injuries were excluded. RTS tests included the following: repeat sprint ability, dynamic valgus, proagility, unilateral counter movement jump (CMJ), isokinetic, triple hop test, and functional movement screen (FMS). All statistical analyses were performed with STATA version 18.0. Results: Ninety five patients underwent RTS tests after ACLR, with a follow-up time of 27.8 months. 71.6 % of patients were men with a mean age of 25.15 ± 10.7 years. The overall re-rupture rate was 13.68 % (13 patients). When comparing patients who passed and did not pass the RTS tests, there were no differences by sex (p = 0.06) or age (p = 0.11). The only statistically significant difference between the groups was the mean risk score (passed: 11.5 ± 0.7 vs. not passed: 15.5 ± 2.1; p < 0.001). Patients with re-rupture were more likely to be from the non-passed group (passed: 0 % v/s not passed: 18.1 %; p = 0.03), with a statistical power of 0.70. Conclusion: Our records show that passing RTS test after an ACLR could guarantee the absence of re-rupture in the medium term
High satisfaction and functional improvement following robotic‐assisted total knee arthroplasty: A Latin American cohort study
(2025) Calvo, Rafael; Figueroa, David; Landea, Daniela; Gonzalez, Waldo; Isla, Jorge; Figueroa, Loreto
Purpose: Total knee arthroplasty (TKA) is a widely performed surgical procedure for patients with severe knee osteoarthritis, aiming to reduce pain, improve function, and enhance quality of life. Patient satisfaction following TKA typically ranges from 85% to 90%, with factors such as malalignment and postoperative instability being common causes of dissatisfaction. Robotic-assisted TKA (RA-TKA) has demonstrated advantages in surgical precision and better functional recovery compared to conventional techniques. The objective of our study is to evaluate and quantify the level of patient satisfaction and functional outcomes after robotic-assisted TKA. Methods: Prospective cohort of patients who underwent TKA using robotic-assisted surgery at a single centre between 2018 and 2020. Demographic data were collected, and patient satisfaction was evaluated at the 1-year follow-up using the Knee Society Scoring (KSS) system. Functionality was assessed through patient-reported outcome measures (PROMs), specifically the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), both preoperatively and postoperatively, with a minimum follow-up period of 3 years. All statistical analyses were performed using STATA version 18.5. Results: A total of 270 patients with complete follow-up were evaluated. 92.6% (n = 250) of patients were satisfied or very satisfied with the surgery, while 7.4% (n = 20) reported dissatisfaction. No statistically significant difference was found in age, sex, BMI, or preoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) between the satisfaction and dissatisfaction groups. However, satisfied patients had a significantly higher postoperative KOOS JR (p = 0.0001). Conclusion: A high level of satisfaction and significant functional improvements were achieved after robotic-assisted TKA in patients with severe osteoarthritis.
Orthopedic Residency Programs: What are Our Current Goals? An International Society of Orthopedic Centers (ISOC) Delphi Consensus
(2025) Figueroa, David; Moya, Luis; Arteaga, José; Alex Vaisman; Bostrom, Mathias; Acuña, Carolina; Alesi, Domenico; Radice, Fernando; Figueroa, Francisco; Toro, Felipe; Liebergall , Meir; Stegeman, Mark; Tagil, Magnus; Lenza, Mario; Sancheti, Parag; Ranawat, Amar; Calvo, Rafael; Guiloff, Rodrigo; Robbins, Laura; Irarrazaval, Sebastian; Zaffagnini, Stefano; Jung, Tobias; Winkler, Tobias
This article presents an international consensus reached by the International Society of Orthopaedic Centers (ISOC) to establish recommendations on postgraduate orthopedic education. Using the Delphi technique, expert opinions from different regions of the world were collected and analyzed. Twenty statements were evaluated, of which 16 achieved strong consensus, 2 moderate consensus, and 2 did not reach consensus. Key recommendations include the implementation of objective metrics to assess competencies, the integration of ethical and professional standards into the curriculum, the use of high-fidelity simulations and advanced technologies such as virtual reality and telemedicine, the promotion of inclusive and non-discriminatory environments, and the establishment of quotas to ensure sufficient hands-on surgical training. The importance of balancing clinical demands with the mental health needs of residents and fostering interdisciplinary collaboration was also emphasized. The consensus aims to provide a framework for improving orthopedic residency programs, adapting them to current challenges and promoting innovation and better patient outcomes. Limitations such as variability in resources and needs between institutions are acknowledged, and it is proposed to continue with future research and adaptations to maintain the relevance of the recommendations.
Surgical Technique of Medial Collateral Ligament Repair of the Knee with Bioinductive Membrane Augmentation
(2026) Figueroa, David; González, Waldo; Arteaga, José; Godoy, Diego
Introduction: The medial collateral ligament (MCL), a primary stabilizer against valgus forces, often requires surgical intervention in severe injuries, especially when associated with anterior cruciate ligament (ACL) tears. However, MCL repair or reconstruction is typically reserved for patients who continue to experience persistent valgus instability after nonoperative management has failed. The use of synthetic and biological implants is increasingly popular to augment these procedures, providing both biomechanical reinforcement and promoting natural healing. BioBrace, a biocomposite of collagen and bioabsorbable microfilaments, provides structural support and enhances tissue healing. This article explores the surgical treatment of high-grade medial collateral ligament (MCL) injuries of the knee using BioBrace augmentation through a case series. Methods: Cohort of patients who underwent MCL repair surgery with a bioinductive membrane augmentation (BioBrace) between December 2023 and February 2024. This article presents surgical techniques, indications, and clinical outcomes from a case series, highlighting the benefits of BioBrace augmentation in improving stability and functional recovery. Results: A total of 4 patients underwent MCL repair surgery with BioBrace. Results show that patients experienced reduced instability, faster rehabilitation, and favorable outcomes without significant postoperative complications. Conclusion: This method offers a promising alternative for patients with complex knee injuries, especially athletes, by facilitating early rehabilitation and improving joint stability. Further research is recommended to evaluate long-term efficacy and optimize the surgical approach.
Collateral status predicts functional outcome in early-treated large-core anterior circulation stroke
(2026) Gallardo, Andrés; Lavados, Pablo; Albiña-Palmarola, Pablo; Cavada, Gabriel; Roldán, Andrés; Olavarría, Verónica V.
Background and purpose: Endovascular therapy (EVT) is increasingly offered to patients with large-core acute ischemic stroke (AIS), yet outcomes remain highly heterogeneous. Collateral circulation may be a key determinant of infarct evolution and recovery, but its role in early-window large-core stroke is not fully defined. Methods: We retrospectively analyzed consecutive adults from a prospective stroke registry who presented within 6 h with anterior-circulation large-vessel occlusion, NIHSS ≥6, and a large ischemic core (MRI core >50 mL or CT perfusion core >70 mL, up to 150 mL). All patients received reperfusion therapy (intravenous thrombolysis, EVT, or both). Collateral status on baseline single-phase CTA was graded using the Tan scale (0–3); no patients had grade 3. The primary outcome was 90-day modified Rankin Scale (mRS); secondary outcome was NIHSS at discharge. Results: Fifty-four patients met inclusion criteria (Tan 0: n = 24; Tan 1: n = 14; Tan 2: n = 16). Baseline NIHSS, ASPECTS, and core volume were similar across groups. Patients without collaterals (Tan 0) had worse 90-day outcomes (median mRS 4 [IQR 3–6]) compared with those with Tan 1 (2 [IQR 1–3]) or Tan 2 (1 [IQR 1–2]) collaterals (both p < 0.001), whereas Tan 1 and Tan 2 did not differ significantly (p = 0.27). NIHSS at discharge showed a similar gradient. In proportional-odds logistic regression, each one-grade increase in collateral status was associated with lower odds of worse 90-day mRS (adjusted per-grade OR 0.32; 95% CI 0.15–0.68; p = 0.003). Conclusion: In early-treated large-core AIS, even simple CTA-based collateral assessment strongly predicts recovery. Patients with absent collaterals follow a distinctly poorer trajectory, while those with any collateral filling behave more favorably. Incorporating collateral status into routine evaluation may improve prognostic accuracy and support treatment decisions in this challenging subgroup.
Rethinking the Schenck Classification for Multiligament Knee Injuries: Evaluating Whether the Schenck KD Grade Is Associated With the Presence of Vascular or Neurological Injuries in a Multicenter Study With 144 Patients
(2025) Sanchez, Enrique; Lozano, Beatriz; Andrade, Renato; Valente, Cristina; Espregueira, João; Figueroa, Francisco; Figueroa, David; Vuylsteke, Kristien; Verdonk, Peter; Passarelli , Luís Eduardo; Janson Angelini, Fabio; Zijl, Jacco; Wolterbeek, Nienke; Maestro, Antonio
Background: Posterolateral corner (PLC) lesions and knee dislocations (KDs) have been recognized as risk factors for vascular and neurological injuries in patients with multiligament knee injury (MLKI), but an association between Schenck KD grade and neurovascular lesions has yet to be established. Hypothesis: The ligamentous injury pattern in MLKIs with high KD grades will be associated with a higher likelihood of vascular and neurological injuries. Study design: Cross-sectional study; Level of evidence, 3. Methods: Included were 144 patients from a multicenter database with surgically treated MLKI. All patients were skeletally mature, had MLKI lesion identified on magnetic resonance imaging and confirmed intraoperatively, and did not have any previous knee surgery or previous vascular or neurological lesions. Demographic data (sex, age), injury mechanism (high energy, sports injury, low energy), ligaments injured, and neurological and vascular lesions were recorded. A new classification for MLKI based on ligamentous injury pattern, and intended for all MLKIs (with and without KD) was developed, and all patients were categorized according to this classification. Associations were evaluated between the risk of vascular and neurological lesion and demographic data, injury mechanism, and new classification grade. Results: The mean patient age was 33.9 years (range, 15-64 years), and 72% were male. High-energy trauma was the most common injury mechanism (55.6%). Vascular injury was present in 5 patients (3.5%) and nerve injury in 17 (11.8%), with 1 patient (0.7%) having both. None of the analyzed variables were associated with the presence of vascular lesion. Univariate logistic regression showed that medial collateral ligament (MCL) lesion decreased the probability of neurological injury (odds ratio [OR], 0.29; 95% CI, 0.1-0.87; P = .03) while PLC injury increased that probability (OR, 12.66; 95% CI, 1.63-100; P = .02). Multivariate logistic regression showed that the proposed MLKI grade was significantly associated with the presence of neurological lesions, with a 2.5-fold increase in the odds of having a neurological injury for each increase in grade (OR, 2.47; 95% CI, 1.36-4.50; P = .003). Conclusion: PLC injuries increased the odds of neurological injury in MLKI, while MCL injuries decreased these odds. MLKI grade and presence of PLC injury was associated with the presence of neurological injury. MLKI grade was not associated with the presence of a vascular lesion.
Integration of RNA Editing into Multiomics Machine Learning Models for Predicting Drug Responses in Breast Cancer Patients
(2026) Bernal, Yanara; Blanco, Alejandro; Oróstica, Karen; Delgado, Iris; Armisen, Ricardo
Background: The integration of multi-omics data, such as genomics and transcriptomics, into artificial intelligence models has advanced precision medicine. However, their clinical applicability remains limited due to model complexity. We integrated DNA mutation, RNA expression, and A>I(G) RNA editing data to develop a predictive model for drug response in breast cancer. Methods: We analyzed 104 patients from the Breast Cancer Genome-Guided Therapy Study (ClinicalTrials.gov: NCT02022202). Clinical variables, gene expression, tumor and germline DNA variants, and RNA editing features were integrated into machine learning models to predict therapy response. Generalized linear models (GLM), random forest (RF), and support vector machines (SVM) were trained and evaluated across multiple random 70/30 train-test splits. Feature selection was performed exclusively within the training set using LASSO regularization. Model performance was assessed using the F1-score on independent test sets. The additive effect of RNA editing was evaluated using paired comparisons across identical train/test splits. Results: We characterized the cohort using clinical, mutational, transcriptomic, and RNA editing profiles in 69 non-responders and 35 responders. Across repeated splits, adding RNA editing frequently maintained or modestly improved predictive performance, particularly in expression-based models, with paired analyses showing a statistically significant increase in F1-score. Conclusions: RNA editing represents a complementary molecular layer that can enhance multi-omic models for therapy response prediction in breast cancer, supporting further investigation of epitranscriptomic features in precision oncology.
Transcription-Coupled Repair Promotes the Retention of Mutations in Coding Regions During Replication Stress
(2026) Zambrano, Evelyn; Fierro, Cristopher; Morales, Fernanda; Manterola, Marcia; Marin, Arnaldo; Armisen, Ricardo; Marcelain, Katherine
Replication stress (RS) is a primary driver of genomic instability in cancer, yet the contribution of transcription-coupled repair (TC-NER) to this process remains unclear. Here, we investigate how the TC-NER factor ERCC6 (CSB) shapes mutational landscapes under RS. We found that ERCC6 deficiency biases early damage signaling toward a 53BP1-mediated response, ultimately leading to senescence. Conversely, ERCC6-proficient cells prioritize survival and proliferative recovery but at the expense of distinct genomic alterations. Whole-exome sequencing reveals that ERCC6 proficiency is associated with the retention of stress-induced mutations specifically within coding regions of transcriptionally active loci, whereas ERCC6-deficient cells accumulate variants primarily in intergenic regions. These findings suggest that while ERCC6 safeguards transcriptional continuity during RS, its activity is associated with a biased retention of stress-induced mutations within coding regions in the surviving cell population. These findings reveal a previously unrecognized link between transcription-coupled repair and mutation distribution in human cells, linking TC-NER to context-dependent somatic evolution and tumor heterogeneity.
Competencias digitales en la formación de profesionales de enfermería: reflexiones sobre modelos teóricos, integración y desafíos
(2025) Contreras, Jorge; Pérez, Claudia
INTRODUCCIÓN. En los últimos años, la educación superior ha atravesado un proceso de transformación acelerado por la integración de competencias digitales, fundamentales en la formación docente. Estas competencias resultan clave tanto para la enseñanza general como para la preparación efectiva de los futuros profesionales de enfermería para desempeñarse en entornos clínicos cada vez más digitalizados. Este artículo presenta un ensayo teórico reflexivo, basado en una revisión conceptual de marcos teóricos. OBJETIVO. analizar las competencias digitales en el ámbito universitario, identificar los modelos que las sustentan y discutir su aplicación en contextos educativos actuales. MÉTODO. Se exploran modelos teóricos, como Krumsvik, Pozos, TPACK y DigCompEdu, que ofrecen perspectivas sobre cómo las competencias digitales pueden integrarse eficazmente en la educación superior. Se discuten las fortalezas y limitaciones de estos modelos. Finalmente, se propone un esquema teórico basado en tres bucles dinámicos: didáctico, curricular y metodológico, para facilitar la integración efectiva de las competencias digitales en la enseñanza. CONCLUSIÓN: En el ámbito de la enfermería, estas competencias son clave para preparar a los futuros profesionales para un entorno clínico altamente tecnificado, mejorando tanto la calidad de la enseñanza como el cuidado de los pacientes. INTRODUCTION. In recent years, higher education has undergone a rapid transformation driven by the integration of digital competencies, which are essential in teacher training. These skills are key not only for general teaching but also for the effective preparation of future nursing professionals to work in increasingly digitalized clinical environments. This article presents a reflective theoretical essay based on a conceptual review of theoretical frameworks. OBJECTIVE. To analyze digital competencies in the university context, identify the models that support them, and discuss their application in current educational settings. METHOD. Theoretical models such as Krumsvik, Pozos, TPACK, and DigCompEdu are explored, offering insights into how digital competencies can be effectively integrated into higher education. The strengths and limitations of these models are discussed. Finally, a theoretical framework is proposed based on three dynamic loops—didactic, curricular, and methodological—to facilitate the effective integration of digital competencies into teaching. CONCLUSION. In the field of nursing, these competencies are essential for preparing future professionals for highly technological clinical environments, thereby enhancing both the quality of teaching and patient care.
Unmet supportive care needs of young women with breast cancer in Chile during follow-up stage after treatment: A qualitative study
(2025) Vezzani, Francisca; Cabieses, Báltica; Obach, Alexandra; Torrealba, Sonia; Carvajal, Iderta
Background: Breast cancer is a significant public health issue, with a rising incidence in young women who have more aggressive tumors and a poorer prognosis. In 2022, breast cancer accounted for 20.8% of all cancers in women in Chile, highlighting the urgent need for targeted research and support for young survivors. This study aims to explore the unmet supportive care needs of these young women during their follow-up period post-treatment, addressing gaps in existing literature and healthcare responses. Methods: Qualitative case study using semi-structured online interviews with 20 women who had a cancer diagnosis under 45 years of age. A thematic content analysis was conducted. Study approved by the Scientific Ethics Committee of the Universidad del Desarrollo, Chile. Results: Three primary areas of concern and unmet supportive care needs were identified during follow-up period: access to information, rehabilitation and integration, and mental health. These areas are deeply interconnected, and the absence of validation of these young women's needs leads to a lack of adequate and comprehensive support from health professionals, deepening women's sense of abandonment by the health system. Discussion and conclusion: The findings align with international literature, revealing that young women face unique challenges related to their life course. The lack of adequate support from healthcare professionals highlights the need for a multidisciplinary, person- and family-centred approach to care. It should address interlinked needs and advocate the involvement of patient organisations. This would enhance support and education regarding the needs of young women and their overall well-being during recovery process.
Global health education programs: Are we embedding contemporary global health needs into the curriculum of master's programs?
(2026) Singh, Samraj; Roberts, Antonia; Cabieses, Báltica; Mezones, Edward; Al-Kassab, Ali; Espinoza, Manuel
Introduction: Global health education (GHE) is expected to prepare professionals to address complex, interlinked global challenges. However, current GHE structures often reflect persistent power asymmetries between the Global North and South, limiting the development of a truly global and equitable health workforce. This review examines how global health master's programs are distributed geographically and to what extent their thematic focus and core curricular content reflect current global health priorities, particularly those related to equity and social justice. Methods: A mapping review of 86 graduate-level GHE programs worldwide was conducted to examine their geographic distribution, thematic focus, and curricular content. Programs were categorized by region and analyzed for thematic emphasis and pedagogical approaches, based on publicly available information on modules and learning activities. Results: The review found that 84% of GHE programs are offered by institutions in the Global North. Programs in the Global South are fewer but tend to emphasize environmental health, governance, and community engagement, often incorporating experiential learning. Across all regions, key topics such as health systems, global health challenges, sustainability, law, ethics, and human rights are unevenly integrated. This variability risks producing graduates with inconsistent competencies to address global health priorities. The dominance of Global North institutions in GHE reflects broader structural inequities in global health. While emerging North-South and South-South collaborations and field-based learning suggest a shift toward more reciprocal models, many programs lack clearly defined aims and accountability frameworks. Discussion: To advance GHE, curricula must embed equity, interdisciplinarity, and regional relevance. Explicit learning outcomes should include power analysis and partnership-building, co-designed and co-delivered with institutions and communities from both the Global North and South. Such reforms are essential to cultivate a workforce capable of addressing global health challenges with contextual sensitivity and systemic insight.
"Le quita el pecho a su hijo y se va a trabajar”: estereotipos de indianidad y violencias históricas en la percepción de equipos de salud sobre la maternidad de migrantes bolivianas en Chile
(2026) Carreño Calderón, Alejandra; Murray, Marjorie
Background: The presence of adolescents in migration flows through Latin America and Caribbean (LAC) has increased in recent years. Adolescents are usually considered healthy due to their low mortality rates compared to the general population. However, existing research shows that adolescence is a phase of life in which mental health, sexual and reproductive health and other needs may increase. Migration, as a social determinant of health, can lead to experiencing compounded vulnerabilities among adolescent migrants, especially those already living in disadvantaged conditions. Objective: aims to estimate and compare social inequalities in health faced by adolescent migrants from LAC living in Chile versus locals, as well as to unveil perceptions and experiences related to additional barriers to accessing to healthcare in the country. Method: A mixed methods study was designed to socially and epidemiologically characterise the adolescent migrant population in Chile. First, two population-based surveys (CENSO 2017; CASEN 2022; REM 2021 and EH 2021) and national epidemiological records were analysed. Second, perceptions and experiences of accessing primary healthcare services were explored through 42 in-depth interviews with healthcare teams (n = 18) and parents of adolescent migrants (n = 24). Quantitative and qualitative data were analysed separately and then integrated to identify the main findings. The study was approved by the Ethics Committee of the Universidad del Desarrollo. Results: The study identified social inequalities negatively affecting adolescent migrant compared with their Chilean peers, including lower access to education, housing and higher chances of having to work. Regarding health, sexual and reproductive needs and experiences are identified, including adolescent pregnancy. Barriers to access to primary healthcare programmes dedicated to adolescent health, which are little known and underused by the migrant population, were also identified. Conclusions: Adolescent migrants in Chile face important social inequalities in health compared to locals and additional barriers to exercise their right to health, putting their current and future health at risk. Priority actions are needed for this specific group, and must focus on increasing the acceptability and coverage of preventive care, as well as strengthening their participation in the social and health decisions affecting them.
Addressing health inequalities and barriers to access among adolescent migrants in Chile: a mixed methods study
(2025) Carreño Calderón, Alejandra; Obach, Alexandra; Cabieses, Báltica; Oyarte, Marcela; Arias, Alicia
Background: The presence of adolescents in migration flows through Latin America and Caribbean (LAC) has increased in recent years. Adolescents are usually considered healthy due to their low mortality rates compared to the general population. However, existing research shows that adolescence is a phase of life in which mental health, sexual and reproductive health and other needs may increase. Migration, as a social determinant of health, can lead to experiencing compounded vulnerabilities among adolescent migrants, especially those already living in disadvantaged conditions. Objective: aims to estimate and compare social inequalities in health faced by adolescent migrants from LAC living in Chile versus locals, as well as to unveil perceptions and experiences related to additional barriers to accessing to healthcare in the country. Method: A mixed methods study was designed to socially and epidemiologically characterise the adolescent migrant population in Chile. First, two population-based surveys (CENSO 2017; CASEN 2022; REM 2021 and EH 2021) and national epidemiological records were analysed. Second, perceptions and experiences of accessing primary healthcare services were explored through 42 in-depth interviews with healthcare teams (n = 18) and parents of adolescent migrants (n = 24). Quantitative and qualitative data were analysed separately and then integrated to identify the main findings. The study was approved by the Ethics Committee of the Universidad del Desarrollo. Results: The study identified social inequalities negatively affecting adolescent migrant compared with their Chilean peers, including lower access to education, housing and higher chances of having to work. Regarding health, sexual and reproductive needs and experiences are identified, including adolescent pregnancy. Barriers to access to primary healthcare programmes dedicated to adolescent health, which are little known and underused by the migrant population, were also identified. Conclusions: Adolescent migrants in Chile face important social inequalities in health compared to locals and additional barriers to exercise their right to health, putting their current and future health at risk. Priority actions are needed for this specific group, and must focus on increasing the acceptability and coverage of preventive care, as well as strengthening their participation in the social and health decisions affecting them.
Mental health and the healthy immigrant effect in Chile: a comparative cross-sectional study with international migrants and locals
(2025) Blukacz, Alice; Oyarte, Marcela; Cabieses, Báltica; Madrid, Paula; Obach, Alexandra
Introduction: The question of whether international migrants appear to be in better health than the locals, and whether this "healthy immigrant effect" declines over time is a highly relevant one, especially with regards to mental health. Based on a community-based survey conducted in Santiago, Chile, this study compares the mental health outcomes of international migrants versus local populations and examines differences within the international migrant group of respondents. Methods: Observational cross-sectional study. Data was collected with international migrants and Chilean participants in 2021-2022 through a structured questionnaire. The study examined self-reported stress and mood disorders in relation to demographic, socioeconomic, health, and migration-related factors. Descriptive analyses were conducted for all variables overall and stratified by perceived stress, mood disorders, and migration status. Associations were assessed using Chi-square or Fisher's exact tests, with Cramer's V used to evaluate effect size. Multiple imputation (m = 5) addressed missing data using the mice package in R, followed by generalised logistic regression models fitted across imputed datasets and combined using Rubin's rules; stepwise selection based on AIC was used for variable reduction, and models were run for the full sample and separately for the migrant population. Results: The sample included 1,656 international migrants and 1,664 locals. Being a migrant was negatively associated with reporting stress and mood disorders in all analyses. Among migrants, the main risk factors for stress were perceiving a high number of migrants in the neighbourhood and having experienced abuse as a migrant and for mood disorders the main risk factor was reporting having experienced abuse as a migrant as well as a longer stay in Chile. Discussion: We found a healthy immigrant effect for mental health among international migrants in Chile, which declined over time in the case of mood disorders. Chilean participants reported very high levels of mental health issues, consistent with existing studies. However, results for international migrants highlight both risk and protective factors linked to migration processes, which are unique to them, warranting a specific approach to their mental health needs.
Desigualdades en salud en Chile post COVID-19: adscripción y acceso efectivo según sexo y condición migrante
(2025) Nuñez, Marilaura; Delgado, Iris; Matute, María Isabel; Cabieses, Báltica; Munoz Venturelli, Paula
Introducción: En 2022, tras la pandemia de COVID-19, aproximadamente el 93% de los países de la Región de las Américas continuaron reportando interrupciones en los servicios esenciales de salud, con peores resultados en los grupos sociales vulnerables. El presente estudio busca describir las barreras de acceso a la atención médica en Chile, desagregadas por sexo y condición de migrante internacional. Métodos: Estudio transversal que analizó los resultados de la encuesta CASEN 2022 a personas ≥18 años. Se calculó la adscripción, el acceso efectivo y las barreras de salud según la condición de migrante internacional y el sexo. Se realizaron modelos de regresión logística múltiple ajustando por edad, ruralidad, nivel educativo, ocupación y quintil de ingresos. El modelo se expresó como Odds Ratio ajustado (ORadj) con un intervalo de confianza del 95% en STATA v.18.5. Resultados: En Chile, en el año 2022, un total de 14.767.688 personas participaron en este estudio, con una edad media de 45,4 años (DE: 17,8), de las cuales el 51,2% eran mujeres y el 9,27% migrantes. En cuanto al seguro de salud, el 3,11% de la población no estaba afiliada al sistema de salud, siendo los hombres (ORadj: 0,6; IC 95%: 0,54-0,68) y los inmigrantes (ORadj: 10,3; 8,78-12,15) los grupos más afectados. En cuanto al acceso efectivo, el 17,4% tenía necesidades de salud, con predominio del sexo femenino (ORadj: 1,3; IC 95%: 1,21-1,32). Sin embargo, de quienes tenían necesidades y las expresaron, el 39,2% expresó necesidades no satisfechas, con mayor probabilidad de mostrarlo en mujeres (ORadj: 1,2; IC 95%: 1,10-1,27). Conclusiones: En Chile, la cobertura del sistema de salud sigue siendo un desafío para los hombres y la población migrante. Observamos con preocupación los altos porcentajes de necesidades de salud insatisfechas, especialmente entre las mujeres. La intersección del sexo y la migración internacional revela una doble vulnerabilidad en el acceso a la atención médica que justifica un estudio más profundo.

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