Position paper on perioperative management and surgical risk in the patient with cirrhosis.

INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Current vision on diagnosis and comprehensive care in hepatic encephalopathy.

The first clinical guidelines on hepatic encephalopathy were published in 2009. Almost 14 years since that first publication, numerous advances in the field of diagnosis, treatment, and special condition care have been made. Therefore, as an initiative of the Asociación Mexicana de Gastroenterología A.C., we present a current view of those aspects. The manuscript described herein was formulated by 24 experts that participated in six working groups, analyzing, discussing, and summarizing the following topics: Definition of hepatic encephalopathy; recommended classifications; epidemiologic panorama, worldwide and in Mexico; diagnostic tools; conditions that merit a differential diagnosis; treatment; and primary and secondary prophylaxis. Likewise, these guidelines emphasize the management of certain special conditions, such as hepatic encephalopathy in acute liver failure and acute-on-chronic liver failure, as well as specific care in patients with hepatic encephalopathy, such as the use of medications and types of sedation, describing those that are permitted or recommended, and those that are not.

Color prediction of layered dental resin composites with varying thickness.

OBJECTIVE: The aim of this study was to assess the accuracy of a Principal Components Analysis (PCA)-based method for reflectance reconstruction and color estimation of layered dental resin-based composites with different thicknesses. METHOD: Bi-layered samples of different clinically relevant thicknesses were created using shades of VITAPAN Excell (VE), VITAPAN Dentine (VD) and VITA Physiodens (VP), combined with their corresponding enamel shades. Spectral reflectance of all samples was measured over a black background using a non-contact spectroradiometer with CIE 45∘∕0∘ geometry. Two different PCA-based models, built from two different configurations of known samples, were proposed to reconstruct the spectral data and color of unknown layered samples. Root Mean Square Error (RMSE), Goodness of Fit (GFC), as well as ΔE00 with corresponding 50:50% acceptability and perceptibly thresholds (AT and PT) were used as performance assessment. RESULTS: The 5-samples training set approach provided an average RMSE < 0.015 and GFC > 0.999 when measured and predicted spectral reflectances were compared, while for the 9-samples training set, RMSE < 0.0098 and GFC > 0.9999 were obtained. The overall mean color differences obtained with the 5-samples training set approach were ΔE00 = 0.99 (AT% = 96.25% and PT% = 32.50%), while using the 9-samples training set resulted in lower overall mean color differences: ΔE00 = 0.50 (AT% = 99.22% and PT% = 83.87%). SIGNIFICANCE: Within the framework of this study, the two proposed PCA-based configurations allow the prediction of the spectral reflectance of layered dental resin-based composites of different shades and thicknesses, with a high degree of accuracy.

Biomaterials Used for Periodontal Disease Treatment: Focusing on Immunomodulatory Properties.

The growing use of biomaterials with different therapeutic purposes increases the need for their physiological understanding as well as to seek its integration with the human body. Chronic inflammatory local pathologies, generally associated with infectious or autoimmunity processes, have been a current therapeutic target due to the difficulty in their treatment. The recent development of biomaterials with immunomodulatory capacity would then become one of the possible strategies for their management in local pathologies, by intervening in situ, without generating alterations in the systemic immune response. The treatment of periodontal disease as an inflammatory entity has involved the use of different approaches and biomaterials. There is no conclusive, high evidence about the use of these biomaterials in the regeneration of periodontitis sequelae, so the profession keeps looking for other different strategies. The use of biomaterials with immunomodulatory properties could be one, with a promising future. This review of the literature summarizes the scientific evidence about biomaterials used in the treatment of periodontal disease.

On the Construction of Pareto-Compliant Combined Indicators.

The most relevant property that a quality indicator (QI) is expected to have is Pareto compliance, which means that every time an approximation set strictly dominates another in a Pareto sense, the indicator must reflect this. The hypervolume indicator and its variants are the only unary QIs known to be Pareto-compliant but there are many commonly used weakly Pareto-compliant indicators such as R2, IGD+, and ε+. Currently, an open research area is related to finding new Pareto-compliant indicators whose preferences are different from those of the hypervolume indicator. In this article, we propose a theoretical basis to combine existing weakly Pareto-compliant indicators with at least one being Pareto-compliant, such that the resulting combined indicator is Pareto-compliant as well. Most importantly, we show that the combination of Pareto-compliant QIs with weakly Pareto-compliant indicators leads to indicators that inherit properties of the weakly compliant indicators in terms of optimal point distributions. The consequences of these new combined indicators are threefold: (1) to increase the variety of available Pareto-compliant QIs by correcting weakly Pareto-compliant indicators, (2) to introduce a general framework for the combination of QIs, and (3) to generate new selection mechanisms for multiobjective evolutionary algorithms where it is possible to achieve/adjust desired distributions on the Pareto front.

Power-over-fiber in a 10 km long multicore fiber link within a 5G fronthaul scenario.

We evaluate the impact of Power-over-Fiber (PoF) technology on the fronthaul of a 5G-NR network with an Analog-Radio-over-Fiber at 25.5 GHz on a 10 km long multicore fiber. The study in this Letter analyzes the bit error rate (BER) performance for different levels of energy transmitted by the PoF system. 133 mW of maximum optical power at reception is demonstrated showing negligible BER impact or data transmission BER improvement in a dedicated and shared scenario.

Avance de tuberosidad tibial con heteroimplante óseo para el tratamiento de ruptura de ligamento cruzado anterior en caninos / Advance of tibial tuberosity with bone heteroimplant for previous crossed ligament in canine

RESUMEN Las evaluaciones clínica y radiológica son técnicas que se emplean para el diagnóstico de ruptura de ligamento cruzado anterior (RLCA) y para la evaluación posoperatoria de cirugías correctivas. Se planteó como objetivo describir los resultados posoperatorios de la técnica avance de tuberosidad tibial en caninos con RLCA utilizando hueso de origen bovino conservado en glicerina al 98%. Fueron intervenidos 5 caninos con la patología y sin cambios radiológicos marcados en las columnas óseas relacionadas. El heteroim-plante óseo se cortó a manera de cuña y, para determinar su tamaño, se tuvo en cuenta la medida prequirúrgica que necesitaba la rodilla para alcanzar el ángulo de avance de la cresta tibial. Seguidamente se fijó al receptor local con implantes metálicos (agujas de Kirschner y alambre ortopédico). En el posoperatorio, se evaluaron por 90 días signos clínicos como claudicación, dolor al movimiento flexión-extensión e inflamación, según la circunferencia de la rodilla, y se evaluó por 120 días el ángulo de avance tibial y la radiopacidad del heteroimplante con respecto al hueso circunvecino (tuberosidad tibial y tibia caudal). El estudio estableció que los parámetros clínicos y radiológicos tienen un efecto estadísticamente significativo; sin embargo, la evaluación del ángulo de avance tibial no tiene un efecto significativo entre el paciente y los días posquirúrgicos. Durante el periodo de evaluación el heteroimplante óseo bovino demostró ser efectivo para estabilizar una rodilla con RLCA en caninos.

ABSTRACT The clinical and radiological evaluations are techniques used for the diagnosis of the anterior cruciate ligament rupture (LCAR) and the post-operatory assessment of corrective surgeries. It was proposed as an objective to describe the post-operatory results of the advance technique of tibial tuberosity in canines with LCAR using bovine bone conserved in 98% glycerin. Five canines were intervened and with no other radiological changed in the related bone columns. The bone heteroimplant was cut in a wedge-like manner and for its size it was taken into account the pre-operatory measurement that the knee needed to reach the advancement angle of the tibial crest. Next, the bone implant was fixated to the local receptor with metallic implants (Kirschner needles and orthopedic wire). In the post-op, the canines were evaluated for 90 days for clinical signs such as claudication, pain when flexing and extending and inflammation according to the knee circumference, and for 120 days the advancement angle of the tibia and the radiopacitry of the heteroimplant in relation to the surrounding bone. The trial established that the clinical and radiological parameters have a statistically significant effect; however, the evaluation of the tibial advancement angle does not have a significant effect between the patient and the post-operatory days. During the evaluation period, the heteroimplant bovine bone proved to be effective to stabilize the knee in canines with LCAR.

Cosmetic and personal care product use, urinary levels of parabens and benzophenones, and risk of endometriosis: results from the EndEA study.

AIM: To explore the relationship of urinary concentrations of different congeners of benzophenones and parabens with the utilization of cosmetics and personal care products (PCPs) and their impact on the risk of endometriosis, and to evaluate the influence of oxidative stress on associations found. METHODS: This case-control study comprised a subsample of 124 women (35 cases; 89 controls). Endometriosis was confirmed (cases) or ruled out (controls) by laparoscopy, with visual inspection of the pelvis and biopsy of suspected lesions (histological diagnosis). Urinary concentrations of benzophenone-1 (BP-1), benzophenone-3 (BP-3), 4-hydroxibenzophenone (4-OH-BP), methyl- (MeP), ethyl- (EtP), propyl- (PrP), and butyl-paraben (BuP), and biomarkers of oxidative stress [lipid peroxidation (TBARS) and total antioxidant power (TAP)] were quantified. Information was gathered on the frequency of use of cosmetics and PCPs. Associations between the frequency of cosmetics/PCP use, urinary concentrations of benzophenones and parabens, oxidative stress, and endometriosis risk were explored in logistic and linear multivariable regression analyses. RESULTS: The frequency of utilization of certain cosmetics and PCPs was significantly associated with urinary concentrations of benzophenones and parabens. After adjustment for potential confounders, the risk of endometriosis was increased in women in the second versus first terciles of MeP (OR = 5.63; p-value<0.001), BP-1 (OR = 5.12; p-value = 0.011), BP-3 (OR = 4.98; p-value = 0.008), and Æ©BPs (OR = 3.34; p-value = 0.032). A close-to-significant relationship was observed between TBARS concentrations and increased endometriosis risk (OR = 1.60, p-value = 0.070) and an inverse association between TAP concentrations and this risk (OR = 0.15; p-value = 0.048). Oxidative stress results did not modify associations observed between benzophenone/paraben exposure and endometriosis risk. CONCLUSIONS: Our findings indicate that the frequency of cosmetics and PCP utilization is a strong predictor of exposure to certain benzophenone and paraben congeners. These compounds may increase the risk of endometriosis in an oxidative stress-independent manner. Further studies are warranted to corroborate these findings.

Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice.

Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.

Parenting, mental health and economic pathways to prevention of violence against children in South Africa.

BACKGROUND: Parenting programs based on social learning theory have increasing empirical evidence for reducing violence against children. Trials are primarily from high-income countries and with young children. Globally, we know little about how parenting programs work to reduce violence, with no known studies in low or middle-income countries (LMICs). This study examines mechanisms of change of a non-commercialized parenting program, Parenting for Lifelong Health for Teens, designed with the World Health Organization and UNICEF. A cluster randomized trial showed main effects on parenting and other secondary outcomes. We conducted secondary analysis of trial data to investigate five potential mediators of reduced violence against children: improved parenting, adolescent behaviour, caregiver mental health, alcohol/drug avoidance, and family economic strengthening. METHODS: The trial was implemented in rural South Africa with 40 sites, n = 552 family dyads (including adolescents aged 10-18 and primary caregivers). Intervention sites (n = 20) received the 14-session parenting program delivered by local community members, including modules on family budgeting and savings. Control sites (n = 20) received a brief informational workshop. Emotional and physical violence against children/adolescents and each potential mediator were reported by adolescents and caregivers at baseline and 9-13 months post-randomisation. Structural equation modelling was used to test simultaneous hypothesized pathways to violence reduction. RESULTS: Improvements in four pathways mediated reduced violence against children: 1) improved parenting practices, 2) improved caregiver mental health (reduced depression), 3) increased caregiver alcohol/drug avoidance and 4) improved family economic welfare. Improved child behaviour was not a mediator, although it was associated with less violence. CONCLUSIONS: Simultaneously bolstering a set of family processes can reduce violence. Supporting self-care and positive coping for caregivers may be essential in challenging contexts. In countries with minimal or no economic safety nets, linking social learning parenting programs with economic strengthening skills may bring us closer to ending violence against children.

Support for the habitat amount hypothesis from a global synthesis of species density studies.

Decades of research suggest that species richness depends on spatial characteristics of habitat patches, especially their size and isolation. In contrast, the habitat amount hypothesis predicts that (1) species richness in plots of fixed size (species density) is more strongly and positively related to the amount of habitat around the plot than to patch size or isolation; (2) habitat amount better predicts species density than patch size and isolation combined, (3) there is no effect of habitat fragmentation per se on species density and (4) patch size and isolation effects do not become stronger with declining habitat amount. Data on eight taxonomic groups from 35 studies around the world support these predictions. Conserving species density requires minimising habitat loss, irrespective of the configuration of the patches in which that habitat is contained.

Risk and Protective Factors Associated with Childhood Obesity in a Sample of Low-Income, Single Female, Parent/Guardian Households: Implications for Family Therapists.

The United States is in the midst of a childhood obesity epidemic that disproportionately impacts underserved and diverse populations. In this study, in-depth qualitative interviews were conducted with 16 low-income, single, female, parent/guardians of an overweight or obese 3- to 8-year-old from socioeconomically disadvantaged backgrounds. Following the tenets of the thematic analysis approach, interviews focused on identifying risk and protective factors influencing parental and child health behaviors associated with child weight status. Results from the interviews are organized according to the Socioecological Framework to help identify risk and protective factors at various system levels. Findings from this investigation have relevance for family therapists as they can inform clinical and advocacy-focused interventions with disadvantaged families affected by childhood obesity.

Estados Unidos está en medio de una epidemia de obesidad infantil que afecta desproporcionadamente a poblaciones diversas y marginadas. En este estudio, se realizaron entrevistas cualitativas detalladas con 16 madres/tutoras solteras de bajos recursos de un niño de entre 3 y 8 años obeso o con sobrepeso de origen socioeconómicamente desfavorecido. Siguiendo los principios del enfoque del análisis temático, las entrevistas se centraron en reconocer los factores de riesgo y de protección que afectan las conductas de salud de los padres y de los niños asociadas con el peso del niño. Los resultados de las entrevistas están organizados de acuerdo con el marco socioecológico para contribuir a identificar los factores de riesgo y de protección en diferentes niveles del sistema. Los resultados de esta investigación tienen relevancia para los terapeutas familiares, ya que pueden explicar las intervenciones clínicas y centradas en el apoyo con familias marginadas afectadas por la obesidad infantil.

Extinction filters mediate the global effects of habitat fragmentation on animals.

Habitat loss is the primary driver of biodiversity decline worldwide, but the effects of fragmentation (the spatial arrangement of remaining habitat) are debated. We tested the hypothesis that forest fragmentation sensitivity-affected by avoidance of habitat edges-should be driven by historical exposure to, and therefore species' evolutionary responses to disturbance. Using a database containing 73 datasets collected worldwide (encompassing 4489 animal species), we found that the proportion of fragmentation-sensitive species was nearly three times as high in regions with low rates of historical disturbance compared with regions with high rates of disturbance (i.e., fires, glaciation, hurricanes, and deforestation). These disturbances coincide with a latitudinal gradient in which sensitivity increases sixfold at low versus high latitudes. We conclude that conservation efforts to limit edges created by fragmentation will be most important in the world's tropical forests.

Nonlinear optical lattices with a void impurity.

We examine a one-dimensional nonlinear (Kerr) waveguide array which contains a single "void" waveguide where the nonlinearity is identically zero. We uncover a family of nonlinear localized modes centered at or near the void, and their stability properties. Unlike a usual impurity problem, here the void acts like a repulsive impurity causing the center of the simplest mode to lie to the side of the void's position. We also compute the stability of extended nonlinear modes showing significant differences from the usual homogeneous nonlinear array. The transmission of a nonlinear pulse across the void shows three main regimes-transmission, reflection, and trapping at the void's position-and we identify a critical momentum for the pulse below (above) where the pulse gets reflected (transmitted), or trapped indefinitely at the void's position. For relatively wide pulses, we observe a steep increase from a regime of no transmission to a regime of high transmission, as the amplitude of the soliton increases beyond a critical wave-vector value. Finally, we consider the transmission of an extended nonlinear wave across the void impurity numerically, finding a rather complex structure of the transmission as a function of wave vector, with the creation of more and more transmission gaps as nonlinearity increases. The overall transmittance decreases and disappears eventually, where the boundaries separating passing from nonpassing regions are complex and fractal-like.

Teaching GenerationPMTO, an evidence-based parent intervention, in a university setting using a blended learning strategy.

BACKGROUND: Despite the large number of evidence-based practices (EBPs) ready for implementation, they are the exception in usual care, especially for ethnic minority patients, who may not have access to trained health professionals. Providing EBP training as part of a graduate curriculum could help build the pipeline of professionals to provide quality care. METHODS: We conducted a before-after study to determine whether we could implement a blended learning strategy (BL; i.e., in vivo and online training) to teach an EBP in university settings. Feasibility in this pilot was operationalized as knowledge acquisition, satisfaction, fidelity, acceptability, and usability. Using GenerationPMTO as the EBP, our aim was to train graduate students enrolled in Psychology, Social Work, and Family Therapy programs in the EBP in one academic year. Two therapists from a community agency were also students in this pilot. A total of 13 students from five universities were trained in the intervention. Adaptations were made to the intervention and training strategy to optimize training fidelity. Focus groups were conducted with the students to capture their perspective about the training. RESULTS: Students demonstrated significant knowledge acquisition from baseline (Mean = 61.79, SD = 11.18) to training completion (Mean = 85.27, SD = 5.08, mean difference = - 23.48, 95% CI = - 29.62, - 17.34). They also reported satisfaction with the BL format, as measured by teaching evaluations at the end of the course. Instructors received acceptable fidelity scores (range of 7-9 in a 9-point scale). Qualitative findings from focus groups showed support for acceptability and usability of BL training. CONCLUSIONS: BL training in university settings can be conducted with fidelity when provided by appropriately trained instructors. BL that integrates EBP and adaptations may be uniquely applicable for training providers in low-resource and ethnically diverse settings. The BL enhanced knowledge of GenerationPMTO was acceptable and usable to students, and was delivered with high instructor fidelity to the training model.

Species sorting and mass effect along forest succession: Evidence from taxonomic, functional, and phylogenetic diversity of amphibian communities.

Species recovery after forest disturbance is a highly studied topic in the tropics, but considerable debate remains on the role of secondary forests as biodiversity repositories, especially regarding the functional and phylogenetic dimensions of biodiversity. Also, studies generally overlook how alpha and beta diversities interact to produce gamma diversity along successional gradients.We used a metacommunity approach to assess how species sorting (i.e., environmental filtering) and mass effect (i.e., source-sink dynamics) affect 14 complementary metrics of amphibian taxonomic, functional, and phylogenetic diversity along a successional gradient in southern Mexico. As amphibians have narrow environmental tolerances and low dispersal capabilities, we expected that species sorting may be relatively more important than mass effect in structuring amphibian communities.Between 2010 and 2012, we sampled frogs, salamanders, and caecilians in 23 communities distributed in four successional stages: young (2-5 years old) and intermediate (13-28 years old) secondary forests, old-growth forest fragments, and old-growth continuous forest. We assessed 15 ecologically relevant functional traits per species and used a time-calibrated molecular phylogeny.We recorded 1,672 individuals belonging to 30 species and 11 families. Supporting our expectations from the species sorting perspective, from the poorest (younger forests) to the best quality (continuous forest) scenarios, we observed (a) an increase in alpha diversity regardless of species abundances; (b) a clear taxonomic segregation across successional stages; (c) an increase in functional richness and dispersion; (d) an increase in mean phylogenetic distance and nearest taxon index; and (e) a reduction in mean nearest taxon distance. However, 10 species occurred in all successional stages, resulting in relatively low beta diversity. This supports a mass effect, where interpatch migrations contribute to prevent local extinctions and increase compositional similarity at the regional scale.Our findings indicate that amphibian metacommunities along forest successional gradients are mainly structured by species sorting, but mass effects may also play a role if high levels of forest cover are conserved in the region. In fact, secondary forests and forest fragments can potentially safeguard different aspects of amphibian diversity, but their long-term conservation value requires preventing additional deforestation.

Influence of Bleaching and Aging Procedures on Color and Whiteness of Dental Composites.

Bleaching can cause perceptible color changes on resin-based composite (RBC) restorations that may not be stable with aging. The objective of this study was to evaluate color stability and whiteness variations of RBCs after bleaching and aging procedures. Discs (10 mm in diameter and 1 mm thick) of shades A2 and A3 were fabricated from two RBCs (Filtek Z250 and Filtek Z350 XT) and divided into three subgroups (for each composite and shade) (n=5) as follows: control (no bleaching), at-home bleaching, and in-office bleaching. All specimens underwent an accelerated artificial aging up to 450 KJ/m2 and 900 KJ/m2 in an aging chamber (Suntest XXL+). A spectroradiometer (SpectraScan PR-670) was used to obtain CIE L*a*b* coordinates. CIEDE2000 color difference (ΔE00) and whiteness index for dentistry (WID) were used to evaluate color stability. Color and whiteness differences data were analyzed considering the 50:50% visual color difference thresholds (perceptibility [PT] and acceptability [AT]) and 50:50% whiteness thresholds (whiteness perceptibility [WPT] and whiteness acceptability [WAT]). Analysis of variance and Tukey tests (α=0.05) were used to statistically analyze the data. After bleaching, all specimens showed ΔE00 and ΔWID values below their corresponding acceptability thresholds (AT and WAT, respectively). After aging, L* and WID values decreased while b* values increased (p≤0.05), resulting in ΔE00 and ΔWID values above AT and WAT, respectively. Color changes after bleaching RBCs were clinically acceptable, while aging provoked clinically perceptible color changes.

Unveiling a Scaling and Universal Behavior for the Magnetocaloric Effect in Cubic Crystal Structures: A Monte Carlo Simulation.

The magnetocaloric effect and the universal character for the magnetic entropy change regarding the cubic crystal structures (SC, BCC, FCC) were investigated, in a qualitative way, using Monte Carlo simulations. A classical Heisenberg Hamiltonian with nearest neighbors, and next nearest neighbors interactions was implemented. In order to compute the critical temperature of the system depending on the coordination number, it was calculated the dependence of the magnetization and magnetic susceptibility as a function of temperature. Magnetic field dependence on the magnetization for isothermal processes was performed considering a magnetocrystalline anisotropy term. In this way, the magnetic entropy change (ΔSm) was computed. Results show that the rescaled ΔSm as well as the exponent (n) characterizing the field dependence of the magnetic entropy change curves, collapse onto a single curve for the studied crystal structures. By this reason, it can be assured that ΔSm exhibits a universal behavior regarding the strength and contribution of the magnetic exchange energy to the total magnetic energy.

Healing through Parenting: An Intervention Delivery and Process of Change Model Developed with Low-Income Latina/o Immigrant Families.

Low-income Latinas/os are exposed to widespread mental health disparities in the United States. Most recently, a resurgence of anti-immigration narratives has led vulnerable Latina/o immigrants to experience considerable contextual stressors with multiple deleterious consequences for their overall well-being, including significant disruptions to their parenting practices. Within this context of adversity and despite the multiple benefits associated with parent training (PT) prevention interventions, the availability of contextually and culturally relevant PT interventions remains limited in underserved Latina/o communities. This paper constitutes a contribution to this gap in knowledge by presenting a model of intervention delivery utilized in the dissemination of culturally adapted versions of the evidence-based intervention known as GenerationPMTO.© The proposed model also describes a process of change that we have documented in empirical research with low-income Latina/o immigrant parents who have been exposed to the adapted interventions. The manuscript is organized in four sections. First, an overview of the model is discussed, along with a brief summary of major theories. Next, the core components of the model are described, complemented by the presentation of a case study. Finally, implications for prevention and clinical intervention are discussed.

Los latinos de bajos recursos están expuestos a amplias desigualdades relacionadas con la salud mental en los Estados Unidos. Recientemente, un resurgimiento de relatos antiinmigratorios han llevado a los inmigrantes latinos vulnerables a sufrir considerables factores desencadenantes de estrés contextual con varias consecuencias perjudiciales para su bienestar general, por ejemplo, interrupciones significativas a sus prácticas de crianza. Dentro de este contexto de adversidad, y a pesar de los múltiples beneficios asociados con las intervenciones preventivas de capacitación para padres, la disponibilidad de intervenciones de capacitación para padres contextualmente y culturalmente relevantes siguen siendo limitadas en las comunidades latinas marginadas. Este artículo constituye un aporte a este déficit de conocimiento mediante la presentación de un modelo de aplicación de intervenciones utilizado en la difusión de versiones culturalmente adaptadas de la intervención de base factual, conocida como GenerationPMTO.© El modelo propuesto también describe un proceso de cambio que hemos documentado en la investigación empírica con padres inmigrantes latinos de bajos recursos que han estado expuestos a las intervenciones adaptadas. El manuscrito está organizado en cuatro secciones. Primero, se debate una presentación general del modelo junto con un breve resumen de teorías principales. Luego, se describen los componentes principales del modelo, complementados por la presentación de un caso práctico. Finalmente, se debaten las consecuencias para la prevención y la intervención clínica.