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1.
Arch Sex Behav ; 52(4): 1355-1363, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36811815

RESUMEN

Extramarital partnerships are highly stigmatized in many societies and are typically excluded from studies of family dynamics and social support. Nevertheless, in many societies such relationships are common and can have important impacts on resource security and health outcomes. However, current studies of these relationships come mainly from ethnographic studies, with quantitative data extremely rare. Here we present data from a 10-year study of romantic partnerships among a community of Himba pastoralists in Namibia, where concurrency is common. The majority of married men (97%) and women (78%) currently reported having more than one partner (n = 122). Using multilevel models comparing marital and nonmarital relationships, we found that, contrary to conventional wisdom surrounding concurrency, Himba form enduring bonds with extramarital partners that often last decades and are very similar to marital ones in terms of length, emotional affect, reliability, and future prospects. Qualitative interview data showed that extramarital relationships were imbued with a set of rights and obligations that, while distinct from those of spouses, provide an important source of support. Greater inclusion of these relationships in studies of marriage and family would provide a clearer picture of social support and resource transfers in these communities and help to explain variation in the practice and acceptance of concurrency around the world.


Asunto(s)
Relaciones Extramatrimoniales , Infecciones por VIH , Masculino , Humanos , Femenino , Reproducibilidad de los Resultados , Matrimonio , Esposos , Conducta Sexual , Parejas Sexuales/psicología
2.
Proc Biol Sci ; 287(1922): 20192890, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32156214

RESUMEN

Paternal investment is predicted to be a facultative calculation based on expected fitness returns and modulated by a host of social predictors including paternity uncertainty. However, the direct role of paternity confidence on the patterns of paternal investment is relatively unknown, in part due to a lack of research in populations with high levels of paternity uncertainty. Additionally, much of the work on paternity certainty uses cues of paternity confidence rather than direct assessments from fathers. We examine the effect of paternity assertions on the multiple measures of paternal investment in Himba pastoralists. Despite a high degree of paternity uncertainty, Himba have strong norms associated with social fatherhood, with men expected to invest equally in biological and non-biological offspring. Our behavioural data show patterns that largely conform to these norms. For domains of investment that are highly visible to the community, such as brideprice payments, we find no evidence of investment biased by paternity confidence. However, more private investment decisions do show some evidence of sex-specific titration. We discuss these results in light of broader considerations about paternal care and the mating-parenting trade-off.


Asunto(s)
Evolución Biológica , Conducta Paterna , Conducta Social , Relaciones Familiares , Humanos , Masculino , Reproducción
3.
Am J Hum Biol ; 30(1)2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28994489

RESUMEN

OBJECTIVES: Following predictions from life history theory, we sought to identify acute trade-offs between reproductive effort (as measured by psychological arousal) and somatic maintenance (via functional measures of innate immunity) during conditions of severe energetic imbalance. METHODS: Sixty-six male ultramarathon runners (ages 20 to 37 years) were sampled before and after a lengthy race. Saliva and sera were collected for testosterone and immunological analyses (hemolytic complement activity and bacterial killing ability). Lean body mass was assessed by bioelectrical impedance, and libido was measured using a slideshow of arousing and neutral images. RESULTS: Following predictions, there was a significant decrease in salivary testosterone levels (109.59 pg/mL versus 97.61 pg/mL, P < .001) and arousal scores in response to provocative images (5.40 versus 4.89, P = .001) between prerace and postrace time points. Additionally, participant bacterial killing ability (P = .035) and hemolytic complement activity (P = .021) increased between prerace and postrace. CONCLUSIONS: Decreased libido and testosterone with concomitant heightened innate immune responses suggest a shift in energetic priorities away from reproduction and toward maintenance/defense during a period of energetic stress.


Asunto(s)
Nivel de Alerta/fisiología , Composición Corporal , Inmunidad Innata/fisiología , Reproducción/fisiología , Carrera/fisiología , Testosterona/metabolismo , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Saliva/química , Adulto Joven
4.
Am J Hum Biol ; 29(6)2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28905440

RESUMEN

OBJECTIVES: Across cultures, fosterage has been shown to impact child health. Contextual factors, such as the reason for fosterage and the relationship between foster parent and child, are known to magnify variance in nutritional outcomes for foster children. Another important, but less studied, factor is the role of gender. Sex-biases in physiology and cultural norms are both known to affect child nutrition, and we posit these effects might be magnified in the presence of fosterage. In this study, we investigate how sex interacts with fosterage to affect nutritional outcomes among Namibian pastoralists. METHODS: Anthropometrics for children and adults were collected using standard procedures, and linear models were used to predict the effects of age, sex, and fosterage on height, weight, and body mass index Z-scores. Semi-structured interviews with adults provided context for understanding sex specific reasons for fosterage and biases in investment. RESULTS: Boys in this population have lower nutritional scores than girls, and fostered boys have lower weight and BMI Z-scores than nonfostered boys. Fostered girls have lower height Z-scores and are more likely to be stunted and underweight than nonfostered girls. These effects extend into adulthood, with fostered women being shorter than their nonfostered counterparts. CONCLUSIONS: Sex plays a role in the nutritional impact of fosterage among Himba children. These differences could be related to differential child labor demands, investment patterns, and the divergent reasons girls and boys are placed into fosterage. Future studies should consider how fosterage can magnify existing biases, like sex, when studying its impact on child health.


Asunto(s)
Antropometría , Fenómenos Fisiológicos Nutricionales Infantiles , Niño Acogido , Adolescente , Crianza de Animales Domésticos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Namibia , Factores Sexuales , Adulto Joven
5.
Am J Hum Biol ; 29(5)2017 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-28653779

RESUMEN

OBJECTIVES: Humans-and several other apes-exhibit a unique pattern of post-natal adrenal maturation; however, the causes and consequences of variation in adrenal development are not well understood. In this study, we examine developmental and age-related maturation of the adrenal gland (measured via dehydroepiandrosterone-sulfate [DHEA-S]) for potential life-history associations with growth and mucosal immunity in a rural population of immune-challenged Bolivian juveniles and adolescents. METHODS: Salivary DHEA-S, anthropometrics, and salivary mucosal immunity (secretory IgA [sIgA]) were measured in 171 males and females, aged 8-23. RESULTS: Males with greater energy (i.e. fat) stores showed higher DHEA-S levels. Controlling for age and energetic condition (to control for phenotypic correlation), higher DHEA-S was associated with higher mucosal immunity (sIgA) among both males and females. Higher DHEA-S levels were positively associated with growth (i.e. height and strength) in males. CONCLUSIONS: In accordance with predictions derived from life-history theory, males with higher energy stores secrete more adrenal androgens. This suggests that adrenal maturation is costly and subject to constraints; that is, only males with sufficient reserves will invest in accelerated adrenal maturation. Further, DHEA-S appears to have a measureable influence on immunocompetence in adolescent males and females; therefore, deficits in DHEA-S may have important consequences for health and maturation during this period. Adrenal maturation is an important, but understudied component of human growth and development.


Asunto(s)
Estatura , Sulfato de Deshidroepiandrosterona/metabolismo , Inmunidad Mucosa , Inmunoglobulina A Secretora/metabolismo , Fuerza Muscular , Estado Nutricional , Adolescente , Bolivia , Niño , Femenino , Humanos , Masculino , Población Rural , Saliva/química , Adulto Joven
6.
Mol Biol Evol ; 32(2): 422-39, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25389206

RESUMEN

Although parasitic organisms are found worldwide, the relative importance of host specificity and geographic isolation for parasite speciation has been explored in only a few systems. Here, we study Plasmodium parasites known to infect Asian nonhuman primates, a monophyletic group that includes the lineage leading to the human parasite Plasmodium vivax and several species used as laboratory models in malaria research. We analyze the available data together with new samples from three sympatric primate species from Borneo: The Bornean orangutan and the long-tailed and the pig-tailed macaques. We find several species of malaria parasites, including three putatively new species in this biodiversity hotspot. Among those newly discovered lineages, we report two sympatric parasites in orangutans. We find no differences in the sets of malaria species infecting each macaque species indicating that these species show no host specificity. Finally, phylogenetic analysis of these data suggests that the malaria parasites infecting Southeast Asian macaques and their relatives are speciating three to four times more rapidly than those with other mammalian hosts such as lemurs and African apes. We estimate that these events took place in approximately a 3-4-Ma period. Based on the genetic and phenotypic diversity of the macaque malarias, we hypothesize that the diversification of this group of parasites has been facilitated by the diversity, geographic distributions, and demographic histories of their primate hosts.


Asunto(s)
Malaria/parasitología , Plasmodium/genética , Plasmodium/patogenicidad , Primates/parasitología , Animales , Macaca/parasitología , Filogenia , Plasmodium/clasificación , Plasmodium/parasitología , Plasmodium vivax/clasificación , Plasmodium vivax/genética , Plasmodium vivax/patogenicidad , Pongo
7.
Am J Hum Biol ; 27(6): 877-80, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25828095

RESUMEN

OBJECTIVES: Human immune function is strongly influenced by variation in hormone concentrations. The adrenal androgens dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEA-S) are thought to be beneficial to immune function and disease resistance, but physiologically interact with testosterone and cortisol. We predict that DHEA and DHEA-S will interact with these other hormones in determining immunological outcomes. Understanding the interactive effects of these hormones will aid in understanding variability in immunocompetence and clarify discrepancies in human studies of androgen-immune interactions. METHODS: Thirty-eight participants collected morning saliva over three days, from which concentrations of DHEA, DHEA-S, testosterone, and cortisol were measured, as well as salivary bacteria killing ability to measure innate immune function. From blood collection, serum was collected to measure innate immune function via a hemolytic complement assay, and whole blood collected and processed to measure proliferative responses of lymphocytes in the presence of mitogens. RESULTS: DHEA was negatively correlated with T cell proliferation, and positively correlated with salivary bacteria killing in male participants. Additionally, using regression models, DHEA-S was negatively associated with hemolytic complement activity, but interaction variables did not yield statistically significant relationships for any other outcome measure. CONCLUSIONS: While interactions with other hormones did not significantly relate with immune function measures in this sample, DHEA and DHEA-S did differentially impact multiple branches of the immune system. Generally characterized as immunosupportive in action, DHEA is shown to inhibit certain facets of innate and cell-mediated immunity, suggesting a more complex role in regulating immunocompetence.


Asunto(s)
Sulfato de Deshidroepiandrosterona/metabolismo , Deshidroepiandrosterona/metabolismo , Hidrocortisona/metabolismo , Sistema Inmunológico/metabolismo , Testosterona/metabolismo , Proliferación Celular , Proteínas del Sistema Complemento , Femenino , Humanos , Masculino , Análisis de Regresión , Saliva/química , Linfocitos T/metabolismo
8.
Am J Primatol ; 77(6): 642-50, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25728599

RESUMEN

Despite the implications for the development of life-history traits, endocrine-immune trade-offs in apes are not well studied. This is due, in part, to difficulty in sampling wild primates, and lack of methods available for immune measures using samples collected noninvasively. Evidence for androgen-mediated immune trade-offs in orangutans is virtually absent, and very little is known regarding their pattern of adrenal development and production of adrenal androgens. To remedy both of these deficiencies, sera were collected from orangutans (Pongo pygmaeus morio) (N = 38) at the Sepilok Orangutan Rehabilitation Centre, Sabah, Malaysia, during routine health screenings. Testosterone, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone-sulfate (DHEA-S) were assayed, along with two measures of functional innate immunity. DHEA-S concentrations, but not DHEA, increased with age in this sample of 1-18 year old animals. DHEA concentrations were higher in animals with higher levels of serum bacteria killing ability, while DHEA-S and testosterone concentrations were higher in animals with reduced complement protein activity. Patterns of DHEA-S concentration in this sample are consistent with patterns of adrenarche observed in other apes. Results from this study suggest that in addition to testosterone, DHEA and DHEA-S may have potent effects on immunological activity in this species.


Asunto(s)
Andrógenos/sangre , Deshidroepiandrosterona/sangre , Inmunidad Innata , Pongo pygmaeus/inmunología , Factores de Edad , Andrógenos/inmunología , Animales , Actividad Bactericida de la Sangre , Proteínas del Sistema Complemento/inmunología , Proteínas del Sistema Complemento/metabolismo , Deshidroepiandrosterona/inmunología , Sulfato de Deshidroepiandrosterona/sangre , Sulfato de Deshidroepiandrosterona/inmunología , Malasia , Testosterona/sangre , Testosterona/inmunología
9.
Sci Rep ; 13(1): 22448, 2023 12 17.
Artículo en Inglés | MEDLINE | ID: mdl-38105308

RESUMEN

Isolated indigenous societies who actively avoid sustained peaceful contact with the outside world are critically endangered. Last year, "Tanaru", the lone surviving man of his tribe for at least 35 years, died in Southwest Amazonia, marking the latest cultural extinction event in a long history of massacres, enslavement, and epidemics. Yet in the upper reaches of the Amazon Basin, dozens of resilient isolated tribes still manage to survive. Remote sensing is a reliable method of monitoring the population dynamics of uncontacted populations by quantifying the area cleared for gardens and villages, along with the fire detections associated with the burning of those clearings. Remote sensing also provides a method to document the number of residential structures and village fissioning. Only with these longitudinal assessments can we better evaluate the current no-contact policies by the United Nations and governments, along with the prospects for the long-term survival of isolated tribes. While the world's largest isolated indigenous metapopulation, Pano speakers in Acre, Brazil, appears to be thriving, other smaller isolated populations disconnected from metapopulations continue to be extremely vulnerable to external threats. Our applied anthropological conservation approach is to provide analyses of publicly available remote sensing datasets to help inform policies that enhance the survival and well-being of isolated cultural groups.


Asunto(s)
Incendios , Tecnología de Sensores Remotos , Humanos , Brasil , Crecimiento Demográfico , Conservación de los Recursos Naturales
10.
Evol Hum Sci ; 2: e45, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-37588368

RESUMEN

Where autonomy for partner choice is high, partner preferences may be shaped by both social and ecological conditions. In particular, women's access to resources can influence both the type and number of partnerships she engages in. However, most existing data linking resources and partner choice rely on either priming effects or large demographic databases, rather than preferences for specific individuals. Here we leverage a combination of demographic data, food insecurity scores and trait and partner preference ratings to determine whether resource security modulates partner preferences among Himba pastoralists. We find that while food insecurity alone has a weak effect on women's openness to new partners, the interaction of food insecurity and number of dependent children strongly predicts women's openness to potential partners. Further, we show that women who have more dependants have stronger preferences for wealthy and influential men. An alternative hypothesis derived from mating-market dynamics, that female desirability affects female preferences, had no effect. Our data show that women who face greater resource constraints are less discriminating in the number of partners they are open to, and have stronger preferences for resource-related traits. These findings highlight the importance of ecological signals in explaining the plasticity of mate preferences.

11.
Nat Hum Behav ; 4(1): 20-26, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31332300

RESUMEN

Long-lasting, romantic partnerships are a universal feature of human societies, but almost as ubiquitous is the risk of instability when one partner strays. Jealous response to the threat of infidelity is well studied, but most empirical work on the topic has focused on a proposed sex difference in the type of jealousy (sexual or emotional) that men and women find most upsetting, rather than on how jealous response varies1,2. This stems in part from the predominance of studies using student samples from industrialized populations, which represent a relatively homogenous group in terms of age, life history stage and social norms3,4. To better understand variation in jealous response, we conducted a 2-part study in 11 populations (1,048 individuals). In line with previous work, we find a robust sex difference in the classic forced-choice jealousy task. However, we also show substantial variation in jealous response across populations. Using parental investment theory, we derived several predictions about what might trigger such variation. We find that greater paternal investment and lower frequency of extramarital sex are associated with more severe jealous response. Thus, partner jealousy appears to be a facultative response, reflective of the variable risks and costs of men's investment across societies.


Asunto(s)
Comparación Transcultural , Celos , Relaciones Padres-Hijo , Parejas Sexuales/psicología , Adulto , Relaciones Extramatrimoniales/psicología , Femenino , Humanos , Masculino , Factores Sexuales
12.
Philos Trans R Soc Lond B Biol Sci ; 374(1780): 20180072, 2019 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-31303169

RESUMEN

Matrilineal systems in sub-Saharan Africa tend to co-occur with horticulture and are rare among pastoralists, with the causal arrow pointing from the introduction of cattle to the loss of matriliny. However, most work on this topic stems from either phylogenetic analyses or historical data. To better understand the shift from matrilineal to patrilineal inheritance that occurred among Bantu populations after the adoption of pastoralism, data from societies that are currently in transition are needed. Himba pastoralists, who practice 'double descent', may represent one such society. Using multi-generational ethnography and structured survey data, we describe current norms and preferences about inheritance, as well as associated norms related to female autonomy. We find that preferences for patrilineal inheritance are strong, despite the current practice of matrilineal cattle inheritance. We also find that a preference for patriliny predicts greater acceptance of norm violating behaviour favouring sons over nephews. Finally, we show that there are important generational differences in how men view women's autonomy, which are probably attributable to both changing norms about inheritance and exposure to majority-culture views on women's roles. Our data shed light on how systemic change like the shifts in descent reckoning that occurred during the Bantu expansion can occur. This article is part of the theme issue 'The evolution of female-biased kinship in humans and other mammals'.


Asunto(s)
Relaciones Familiares , Agricultores/psicología , Testamentos , Adolescente , Adulto , África del Sur del Sahara , Cultura , Padre/psicología , Femenino , Identidad de Género , Herencia , Humanos , Masculino , Persona de Mediana Edad , Madres/psicología , Adulto Joven
13.
Vitam Horm ; 108: 125-144, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30029724

RESUMEN

DHEA and DHEA-S have numerous associations with multiple aspects of immune function and are often characterized as beneficial and supportive of immunocompetence. However, closer inspection of these studies reveals confusion regarding the immunological components modified, the mechanisms of action, and degree of impact, and even whether these hormones even have direct action or are mediated by metabolites and interactions with other hormones and hormone receptors. Additionally, much of the research is conducted on rodent models using very high concentrations of hormone supplements, which may not be representative of the effects of these hormones in natural circulating concentrations, or may not translate to human physiology in a meaningful way. Here, we review the effects of DHEA and DHEA-S on immune function and examine the potential roles these hormones play on specific components of immune function. Drawing from the literature on hormone supplementation, as well as studies examining the natural circulating levels of DHEA and DHEA-S on specific immunological components and disease processes, we argue that DHEA has differential actions on human immune function, and that its effects are further shaped by concentrations of other hormones. Of particular interest is the role of DHEA as an antiglucocorticoid, and for its actions on both androgen and estrogen receptors. With additional research, DHEA may be useful as a therapeutic, particularly in diseases with high levels of inflammation, or where adrenal production is altered. The convoluted nature of DHEA-immune interactions makes direct effects difficult to interpret, and future research needs to consider direct, intracrine, and downstream effects of these hormones.


Asunto(s)
Deshidroepiandrosterona/metabolismo , Inmunomodulación/fisiología , Citocinas/genética , Citocinas/metabolismo , Regulación de la Expresión Génica/inmunología , Humanos , Infecciones/inmunología
14.
Sleep Health ; 4(6): 500-508, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30442317

RESUMEN

OBJECTIVE: To understand the basics of sleep quality in a pastoralist population and to explore predictors of this variation. DESIGN: Cross-sectional. SETTING: Northern Namibia, dry seasons of 2016 and 2017. PARTICIPANTS: The Himba, a nonindustrial seminomadic agropastoralist population without access to the electrical grid. MEASUREMENTS: Using Actiwatch-2 devices, 75 participants completed 721 days of wear. We calculated sleep duration, efficiency, and activity counts before and after sunset/sunrise and onset/offset. Participants were also interviewed about sleeping arrangements and nighttime disruptions. RESULTS: Himba show lower sleep duration and efficiency than other populations studied, and men had substantially lower duration and efficiency than women. Sex differences were not attenuated when napping was included with total sleep time. Age predicted longer sleep duration and lower evening and morning activity levels. Number of adult co-sleepers predicted increased sleep duration and efficiency in women. Livestock disturbance was not a commonly reported cause of nighttime waking. CONCLUSIONS: These findings support predictions that pastoralist groups may have lower sleep quality than other subsistence populations, but this does not appear to be a consequence of noise from livestock. Instead, lower sleep quality appears to be the result of subsistence and social activities, particularly for men and young adults overall.


Asunto(s)
Agricultores/psicología , Sueño , Adolescente , Adulto , Factores de Edad , Anciano , Estudios Transversales , Agricultores/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Namibia , Factores Sexuales , Conducta Social , Adulto Joven
15.
Stress Health ; 33(5): 656-664, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28401652

RESUMEN

The androgen dehydroepiandrosterone (DHEA) responds to stress activation, exhibits anti-glucocorticoid properties, and modulates immunity in diverse ways, yet little is known of its role in acute stress responses. In this study, the effects of DHEA and its sulfate ester DHEA-S on human male immune function during exposure to an acute stressor is explored. Variation in DHEA, DHEA-S, testosterone, and cortisol, along with bacterial killing assays, was measured in response to a modified Trier Social Stress test in 27 young adult males. Cortisol was positively related to salivary innate immunity but only for participants who also exhibited high DHEA responses. Additionally, DHEA positively and DHEA-S negatively predicted salivary immunity, but the opposite was observed for serum-based innate immunity. The DHEA response to acute stress appears to be an important factor in stress-mediated immunological responses, with differential effects on immunity dependent upon the presence of other hormones, primarily cortisol and DHEA-S. These results suggest that DHEA plays an important role, alongside other hormones, in modulating immunological shifts during acute stress.


Asunto(s)
Deshidroepiandrosterona/metabolismo , Hidrocortisona/metabolismo , Inmunidad Innata/inmunología , Saliva/inmunología , Saliva/metabolismo , Estrés Psicológico/inmunología , Estrés Psicológico/metabolismo , Adulto , Sulfato de Deshidroepiandrosterona/metabolismo , Humanos , Masculino , Determinación de Anticuerpos Séricos Bactericidas , Testosterona/metabolismo , Adulto Joven
16.
Hosp Pediatr ; 7(11): 642-648, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29046431

RESUMEN

OBJECTIVES: Evaluative assessment is needed to inform improvement of Part 4 Maintenance of Certification (MOC), a large-scale program that aims to improve physician knowledge, engagement, and skills in quality improvement (QI). We sought to determine if Part 4 MOC participation improves perceived educational and clinical outcomes by piloting a new physician survey. METHODS: We administered a new online survey (MOC Practice, Engagement, Attitude, and Knowledge Survey) to physicians at the beginning and end of a Part 4 MOC project sponsored by a pediatric hospital's American Board of Medical Specialties' portfolio program during 2015. Participants worked in academic and community settings and in various accredited specialties. The main outcome was change in survey response on a 5-point Likert scale (1 = best) for 3 learning domains (QI engagement and attitude; QI method application, and improved patient care). RESULTS: Of 123 complete responses and a 97% response rate, mean baseline responses were positive or neutral (2.2, 2.3, 1.9, respectively). Responses improved in QI engagement and attitude (-0.15, z score = -2.78, P = .005), QI method application (-0.39, z score = -7.364, P < .005), and improved patient care (-0.11, z score = -1.728, P = .084). CONCLUSIONS: A Part 4 MOC physician survey provides valuable data to evaluate and improve the learning activity. In this children's hospital program, physicians view Part 4 favorably. Participation was associated with modest improvements in perceptions of QI engagement and attitude, application of QI methods, and patient care. Systematic evaluation of all Part 4 MOC projects and programs has the potential to improve the program nationally.


Asunto(s)
Actitud del Personal de Salud , Certificación , Conocimientos, Actitudes y Práctica en Salud , Pediatría , Mejoramiento de la Calidad , Certificación/normas , Humanos , Médicos/psicología , Autoinforme
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