Implementation of WHO guidelines for cervical cancer screening, diagnosis and treatment: knowledge and perceptions of health providers from Argentina.

BACKGROUND: The 2021 World Health Organization (WHO) guidelines on cervical cancer screening and treatment provide countries with evidence-based recommendations to accelerate disease elimination. However, evidence shows that health providers' adherence to screening guidelines is low. We conducted a study in Argentina to analyze health providers' knowledge and perceptions regarding the 2021 WHO Guidelines. METHODS: A qualitative study was conducted based on individual, semi-structured interviews with health providers specializing in gynecology (n = 15). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. RESULTS: Although health providers perceive WHO as a reliable institution, they do not know the 2021 guidelines, its supporting evidence, and its elaboration process. Their clinical practice is mainly guided by local recommendations developed by national professional medical associations (PMAs). For interviewees, WHO guidelines should be disseminated through health authorities and national PMAs, mainly through in-service training. Health providers had a positive assessment regarding WHO Recommendation 1 (screen, triage, and treatment for women aged 30 + with HPV-testing every 5 to 10 years) and perceived a favorable climate for its implementation. HPV-testing followed by triage was considered a low-complexity practice, enabling a better detection of HPV, a better selection of the patients who will need diagnosis and treatment, and a more efficient use of health system resources. However, they suggested adapting this recommendation by removing screening interval beyond 5 years. WHO Recommendation 2 (screen-and-treat approach with HPV-testing for women aged 30 + every 5 to 10 years) was predominantly rejected by interviewees, was considered an algorithm that did not respond to women's needs, and was not adequate for the Argentinean context. Regarding the HPV-test modality, clinician-collected tests were the preferred mode. Health providers considered that HPV self-collection should be used primarily among socially vulnerable women to increase screening coverage. CONCLUSION: WHO guidelines should be widely disseminated among health providers, especially in settings that could benefit from a screen-and-treat approach. Identifying areas of partnership and collaboration with PMAs in implementing WHO guidelines is essential.

Evaluation of the Newborn Screening Pilot for Sickle Cell Disease in Suriname Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework.

The early detection of sickle cell disease (SCD) is vital to reduce mortality among affected children. Suriname currently lacks a newborn screening programme (NSP) for SCD. We performed a pilot programme to evaluate the scalability of such an initiative. Dried blood spots were collected from five birth centres and subjected to electrophoresis analysis. The programme scalability was evaluated using the non-adoption, abandonment, scale-up, spread, and sustainability framework. Challenges across six domains (illness, technology, value proposition, adopter system, organisation, and societal system), were categorised hierarchically as simple 😊, complicated 😐, or complex 😢. It has been proven that implementing programmes with mainly complicated challenges is difficult and those in mainly complex areas may be unachievable. SCD was detected in 33 of 5185 (0.64%) successfully screened newborns. Most of the domains were classified as simple or complicated. Disease detection and technology suitability for screening in Suriname were confirmed, with favourable parental acceptance. Only minor routine adjustment was required from the medical staff for programme implementation. Complex challenges included a reliance on external suppliers for technical maintenance, ensuring timely access to specialised paediatric care for affected newborns, and securing sustainable financial funding. Scaling up is challenging but feasible, particularly with a targeted focus on identified complex challenges.

Mesomelia-synostoses syndrome: contiguous deletion syndrome, SULF1 haploinsufficiency or enhancer adoption?

BACKGROUND: Mesomelia-Synostoses Syndrome (MSS)(OMIM 600,383) is a rare autosomal dominant disorder characterized by mesomelic limb shortening, acral synostoses and multiple congenital malformations which is described as a contiguous deletion syndrome involving the two genes SULF1 and SLCO5A1. The study of apparently balanced chromosomal rearrangements (BCRs) is a cytogenetic strategy used to identify candidate genes associated with Mendelian diseases or abnormal phenotypes. With the improved development of genomic technologies, new methods refine this search, allowing better delineation of breakpoints as well as more accurate genotype-phenotype correlation. CASE PRESENTATION: We present a boy with a global development deficit, delayed speech development and an ASD (Asperger) family history, with an apparently balanced "de novo" reciprocal translocation [t(1;8)(p32.2;q13)dn]. The cytogenetic molecular study identified a likely pathogenic deletion of 21 kb in the 15q12 region, while mate pair sequencing identified gene-truncations at both the 1p32.2 and 8q13 translocation breakpoints. CONCLUSIONS: The identification of a pathogenic alteration on 15q12 involving GABRA5 was likely the main cause of the ASD-phenotype. Importantly, the chr8 translocation breakpoint truncating SLCO5A1 exclude SLCO5A1 as a candidate for MSS, leaving SULF1 as the primary candidate. However, the deletions observed in MSS remove a topological associated domain (TAD) boundary separating SULF1 and SLCO5A1. Hence, Mesomelia-Synostoses syndrome is either caused by haploinsufficiency of SULF1 or ectopic enhancer effects where skeletal/chrondrogenic SULF1 enhancers drive excopic expression of developmental genes in adjacent TADs including PRDM14, NCOA2 and/or EYA1.

Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study.

BACKGROUND: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce. OBJECTIVE: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. METHODS: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. RESULTS: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). CONCLUSIONS: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues.

Eviction-driven infanticide and sexually selected adoption and infanticide in a neotropical parrot.

Infanticide and adoption have been attributed to sexual selection, where an individual later reproduces with the parent whose offspring it killed or adopted. While sexually selected infanticide is well known, evidence for sexually selected adoption is anecdotal. We report on both behaviors at 346 nests over 27 y in green-rumped parrotlets (Forpus passerinus) in Venezuela. Parrotlets are monogamous with long-term pair bonds, exhibit a strongly male-biased adult sex ratio, and nest in cavities that are in short supply, creating intense competition for nest sites and mates. Infanticide attacks occurred at 256 nests in two distinct contexts: 1) Attacks were primarily committed by nonbreeding pairs (69%) attempting to evict parents from the cavity. Infanticide attacks per nest were positively correlated with population size and evicting pairs never adopted abandoned offspring. Competition for limited nest sites was a primary cause of eviction-driven infanticide, and 2) attacks occurred less frequently at nests where one mate died (31%), was perpetrated primarily by stepparents of both sexes, and was independent of population size. Thus, within a single species and mating system, infanticide occurred in multiple contexts due to multiple drivers. Nevertheless, 48% of stepparents of both sexes adopted offspring, and another 23% of stepfathers exhibited both infanticide and long-term care. Stepfathers were often young males who subsequently nested with widows, reaching earlier ages of first breeding than competitors and demonstrating sexually selected adoption. Adoption and infanticide conferred similar fitness benefits to stepfathers and appeared to be equivalent strategies driven by limited breeding opportunities, male-biased sex ratios, and long-term monogamy.

Medical Expectations of Physicians on AI Solutions in Daily Practice: Cross-Sectional Survey Study.

Background: The use of artificial intelligence (AI) in medicine has been a trending subject in the past few years. Although not frequently used in daily practice yet, it brings along many expectations, doubts, and fears for physicians. Surveys can be used to help understand this situation. Objective: This study aimed to explore the degree of knowledge, expectations, and fears on possible AI use by physicians in daily practice, according to sex and time since graduation. Methods: An electronic survey was sent to physicians of a large hospital in Brazil, from August to September 2022. Results: A total of 164 physicians responded to our survey. Overall, 54.3% (89/164) of physicians considered themselves to have an intermediate knowledge of AI, and 78.5% (128/163) believed that AI should be regulated by a governmental agency. If AI solutions were reliable, fast, and available, 77.9% (127/163) intended to frequently or always use AI for diagnosis (143/164, 87.2%), management (140/164, 85.4%), or exams interpretation (150/164, 91.5%), but their approvals for AI when used by other health professionals (85/163, 52.1%) or directly by patients (82/162, 50.6%) were not as high. The main benefit would be increasing the speed for diagnosis and management (106/163, 61.3%), and the worst issue would be to over rely on AI and lose medical skills (118/163, 72.4%). Physicians believed that AI would be useful (106/163, 65%), facilitate their work (140/153, 91.5%), not alter the number of appointments (80/162, 49.4%), not interfere in their financial gain (94/162, 58%), and not replace their jobs but be an additional source of information (104/162, 64.2%). In case of disagreement between AI and physicians, most (108/159, 67.9%) answered that a third opinion should be requested. Physicians with ≤10 years since graduation would adopt AI solutions more frequently than those with >20 years since graduation (P=.04), and female physicians were more receptive to other hospital staff using AI than male physicians (P=.008). Conclusions: Physicians were shown to have good expectations regarding the use of AI in medicine when they apply it themselves, but not when used by others. They also intend to use it, as long as it was approved by a regulatory agency. Although there was hope for a beneficial impact of AI on health care, it also brings specific concerns.

Demographics and tenure of the Chilean urban dog population. A mathematical model.

BACKGROUND: Irresponsible dog ownership in urban areas is a public health concern with significant implications for human, animal, and environmental welfare. Factors such as abandonment, variations in adoption, insufficient supervision, emerging identification initiatives, and collective feeding impact the growth of stray dog populations and the transmission of diseases. Developing a modeling tool to understand the dynamics of canine population growth and the effect of human behavior on this phenomenon is essential. METHODS: An ordinary differential equation model was developed to depict the growth dynamics and movements of urban dog populations, distinguishing between those with owners (restricted and semi-restricted) and those without (stray and community dogs). Two equilibrium states of the system were analyzed: with and without the presence of individually owned dogs. An increase rate for the population of individually owned dogs was calculated, and a local sensitivity analysis was conducted to assess the impact of parameters on the reduction of this population. Additionally, two global sensitivity analysis methods were used to evaluate the simultaneous influence of the parameters. RESULTS: Findings indicate that system equilibrium depends on various dog categories. Although total eradication of stray and community dogs is unlikely, equilibrium levels are directly related to subpopulation growth rates, responsible ownership practices, and adoption and abandonment rates. The growth rates of the population of dogs without individual owners have a direct and proportional influence on their regulation, while adoption rates have an inverse and proportional effect. The study, through global sensitivity analysis, identifies key parameters for each dog subpopulation. For restricted dogs, environmental carrying capacity is the most variable factor; for semi-restricted dogs, awareness of responsible ownership is crucial. The abandonment of restricted dogs significantly impacts stray dog dynamics, while the transition from stray to community status is an important variable factor for community dogs. CONCLUSION: Addressing the situation of unowned dogs requires a collective effort to reduce risks associated with the spread of zoonotic diseases, environmental pollution, and biodiversity loss, thus contributing to public health and environmental conservation.

Defining the Limits of Acceptable Parenthood: Reproductive Governance in Brazil.

Drawing on sources relating to the Brazilian scenario - from ethnographic research in lower-income neighorhoods to the analysis of official documents and public debates - we build on cases of forced child removals to explore the intersectional dynamics of class, race, and gender that underlie institutionalized practices of discrimination against poverty-stricken families. After first addressing the influence of recent global trends in child-protection policy, we observe how adoption procedures in Brazil have been increasingly facilitated by the resignification of rights and corresponding changes in the country's legal infrastructures. Next, asking what sort of authoritative knowledge is invoked to define a child's best interests, we reflect on the role played by biomedicine in appraising the limits of acceptable parenthood. Guided by the notion of stratified reproduction, our investigation of these political, scientific, and moral technologies suggests plausible connections between policies that condition the demand for and the supply of adoptable children.

Uso da entrega voluntária como barreira de acesso ao aborto legal em projetos de lei recentes no Brasil / Uso de la entrega voluntaria como barrera de acceso al aborto legal en proyectos de ley recientes en Brasil / The use of voluntary relinquishment as a barrier to legal abortion access in recent legislative bills in Brazil

O artigo discute os usos da entrega voluntária, dispositivo em que a mulher opta por entregar o bebê gerado para adoção como estratégia de cerceamento ao aborto legal. Utilizamos como ponto de partida dois casos amplamente divulgados que envolvem gestantes menores de 14 anos - em que o aborto não é penalizado devido à presunção de estupro de vulnerável. Realizamos análise documental com perspectiva etnográfica de projetos de lei recentes que regulamentam ou promovem a adoção/entrega voluntária. O argumento de que existem "30 mil casais" à espera de um bebê para adotar tem sido frequentemente utilizado a fim de atrasar ou impedir o acesso ao aborto legal. Ainda que seja um direito de qualquer gestante, o acionamento desse dispositivo como "solução" para o aborto tem sido um importante instrumento de ataque aos direitos sexuais e reprodutivos no Brasil.

El artículo discute los usos de la entrega voluntaria, medida en la que la mujer opta por entregar al bebé engendrado para adopción, como estrategia de limitación al aborto legal. Utilizamos como punto de partida dos casos ampliamente divulgados que envuelven a gestantes menores de 14 años, casos en los que el aborto no está penalizado debido a la presunción de violación de vulnerable. Realizamos un análisis documental con perspectiva etnográfica de proyectos de ley recientes que reglamentan o promueven la adopción/entrega voluntaria. El argumento de que existen "30 mil parejas" a la espera de un bebé para adopción se ha utilizado frecuentemente con la finalidad de atrasar o impedir el acceso al aborto legal. Aunque sea un derecho de cualquier gestante, la puesta en acción de tal medida como "solución" para el aborto ha sido un importante instrumento de ataque a los derechos sexuales y reproductivos en Brasil.

This paper discusses the use of voluntary relinquishment, a legal mechanism through which pregnant women can choose to place their babies for adoption, as a strategy to curtail legal abortion. We begin with two widely publicized cases involving pregnant girls under the age of fourteen - situations in which abortion is not criminalized due to the presumption of statutory rape. We conduct a documentary analysis from an ethnographic perspective of recent legislative bills that regulate or promote voluntary relinquishment. The argument that there are "30,000 couples" waiting to adopt a baby is often used to delay or prevent legal abortion access. Although it is the right of every pregnant woman, the use of this apparatus as a "solution" to abortion has been an important instrument in attacks on sexual and reproductive rights in Brazil.

Having children in cross-border contexts: late-family formation among homoparental families in Spain / Ter filhos em contextos transfronteiriços: formação familiar tardia entre famílias homoparentais na Espanha

Abstract Considered until recently unfit to rear children, non-heterosexual people have been excluded from forming families in most countries. Many, worldwide, demand access to family formation, claiming the same aptitudes as heterosexual people for raising children. However, when non-heterosexual singles and couples want to become parents in Spain, they must consider transnational contexts, resorting to inter-country adoption or surrogacy abroad, processes that contribute to delay their family formation. They must consider not only Spanish sociocultural conditions, but other countries' legal restrictions regarding parents' gender, social status, and sexual identity. These families experience great difficulty in gaining access to reproductive health services. Based on multi-site ethnographic fieldwork, this text addresses how, despite legislative changes allowing homoparental family formation in Spain, these parents must overcome complex bureaucratic processes when they decide to have children, while facing homophobic attitudes and policies in their quests to become parents.

Resumo Até recentemente as pessoas não heterossexuais foram consideradas inadequadas para criar seus filhos, sendo excluídas da formação de famílias na maioria dos países. Em todo o mundo, estas pessoas exigem acesso à formação familiar, destacando as mesmas competências que as pessoas heterossexuais possuem para os criar seus filhos. No entanto, quando pessoas solteiras e casais não heterossexuais consideram tornar-se pais na Espanha, devem pensar em contextos transnacionais para ter filhos através da adoção ou sub-rogação em outros países, contribuindo para atrasar a sua parentalidade. Elas devem considerar não só as condições socioculturais da Espanha, mas também as dos países de destino em aspectos como gênero, classe social e orientação sexual. Estas famílias enfrentam grandes dificuldades no acesso aos serviços de saúde reprodutiva. Por meio de uma abordagem etnográfica multissituada, este artigo aborda como, apesar das alterações legislativas que permitem a formação de famílias homoparentais na Espanha, estes pais e mães devem superar complicados processos burocráticos e enfrentar atitudes e políticas de exclusão social quando decidem ter os seus filhos e filhas.

Quando a deficiência e a homoparentalidade se encontram: a adoção de crianças com deficiência por casais homoafetivos / When disability and homoparenting meet: the adoption of children with disability by same sex couples

Resumo O ensaio teórico parte de seis reportagens sobre casais homoafetivos e pessoas gays e lésbicas para interseccionar homoparentalidade e adoção de crianças com deficiência, pelas lentes das ciências humanas e sociais em saúde coletiva. As reportagens foram interpretadas à luz dos estudos sobre adoção homoparental e adoção de crianças com deficiência. Abordagens feministas sobre cuidado e deficiência também compuseram o olhar interpretativo, operando como teias expressivas das gramáticas do capacitismo. Verificou-se que as abordagens midiáticas endossam o direito à constituição familiar e à adoção de crianças com deficiência por famílias homoparentais, sem aprofundar criticamente a categoria deficiência e sem destacar apoio à adoção de todos os perfis de adotandos. E que as intersecções entre homofobia e capacitismo incrementam lógicas discriminatórias e de opressão, sendo a união de grupos considerados "indesejáveis" uma estratégia de governamentalidade que revela a complexidade das gramáticas do capacitismo aplicadas aos direitos sexuais e reprodutivos de adotantes LGBTQIA+ e aos direitos fundamentais de crianças e adolescentes com deficiência disponíveis para adoção.

Abstract The present theoretical essay is based on six reports concerning same-sex couples and gay and lesbian people in order to interconnect homoparenting and the adoption of children with disabilities, through the lenses of human and social sciences in public health. The reports were interpreted in light of studies on same-sex adoption and the adoption of children with disabilities. Feminist approaches related to care and disability were also included in the interpretative perspective, operating as expressive webs of grammars of ableism. It was found that media approaches endorse the right to family formation and the adoption of children with disabilities by homoparental families, but with little critical depth on the category of disability and without highlighting support for the adoption of all adoptee profiles. Moreover, the intersections between homophobia and ableism increase discriminatory and oppressive logics, with the union of social groups considered to be "undesirable" representing a strategy of governmentality that reveals the complexity of grammars of ableism, applied to the sexual and reproductive rights of LGBTQIA+ adopters and to the fundamental rights of children and adolescents with disabilities who are available for adoption.

Enablers and barriers to adopt the locally developed Masi mechanical ventilator amid COVID-19 pandemic in Peru.

Background: Limited supply of resources during the COVID-19 emergency encouraged the local development of the Masi mechanical ventilator (MV). Despite the efforts to promote Masi, adopting this innovation faced multiple obstacles, regardless of its performance. We explored the perceptions among healthcare personnel towards incorporating Masi to provide ventilatory support to COVID-19 patients during the second wave in Peru (January to June 2021). Methods: We conducted twelve in-depth virtual interviews. Topics included experience when handling Masi, the impact of the training received, confidence in the device, barriers perceived, and enablers identified. All participants provided verbal informed consent. Results: Most of the participants were male physicians. Participants belonged to seven hospitals that exhibited a wide range of healthcare capacities. Globally, the adoption of Masi MV was driven by the scarcity of ventilatory devices in the wards and reinforced by appropriate training and prompt technical support. Participants reported that Masi's structural and operational features played both advantages and disadvantages. Hospital infrastructure readiness, availability of commercial MVs, mistrust in its simple appearance, and resistance to change among healthcare personnel were perceived as barriers, while low-cost, prompt technical support and user-friendliness were valuable enablers. The first two enablers were observed in participants regardless of their attitude towards Masi. Despite the small number of participants for this qualitative study, it is important to note that the sample size was sufficient to reach saturation, as the topics discussed with participants became redundant and did not yield new information. Conclusions: The perceptions among healthcare personnel to incorporate Masi as a mechanical ventilator for COVID-19 patients showed that communication, training and experience, and peer encouragement were essential to secure its use and sustainability of the technology. A priori judgments and perceptions unrelated to the performance of the novel device were observed, and its proper management may define its further implementation. Altogether our study suggests that along with strengthening local technological development, strategies to improve their adoption process must be considered as early as possible in medical innovations.

"Fui Eu Que Pedi": A Perspectiva de Crianças e Adolescentes Sobre a Dissolução da Adoção / "I Asked For It": The Perspective of Children and Adolescents on the Dissolution of Adoption

Ainda que não exista previsão legal, crianças e adolescentes vivenciam o processo de dissolução da adoção. Na literatura, a vivência subjetiva de crianças e adolescentes frente ao fenômeno tem sido pouco abordada. O presente estudo objetivou conhecer as vivências de crianças e adolescentes que retornaram ao acolhimento após a adoção, além de compreender sua percepção sobre família e as expectativas sobre o futuro. Realizou-se uma pesquisa qualitativa exploratória com três crianças e uma adolescente em uma instituição de acolhimento da região metropolitana de Porto Alegre/RS. Os dados obtidos em entrevistas semiestruturadas e hora do jogo foram examinados por meio de análise temática. Os resultados foram agrupados em quatro temáticas: 1) concepções de família; 2) experiência de adoção; 3) experiências de retorno ao acolhimento; 4) perspectivas de futuro. Identificou-se que as crianças idealizam a família nuclear, amorosa, e avaliam que a decisão de retorno para o acolhimento foi delas, embora suas perspectivas de futuro sejam centradas na expectativa de uma nova adoção. Constatou-se que a experiência de adoção e retorno para o acolhimento é permeada de sofrimento, o que demanda a criação de políticas públicas de atenção a crianças e adolescentes nesse contexto.

Although there is no legal provision, children and adolescents experience the process of adoption dissolution. In the literature, little is discussed about the subjective experience of children and adolescents who face this experience. The present study aimed at investigating the experiences of children and adolescents who returned to the foster care system after being adopted and understanding their perceptions about family and future expectations. An exploratory qualitative study was carried out with three children and one teenager in a foster care institution located in the metropolitan area of Porto Alegre/RS. The data obtained from semi-structured interviews and play were examined through thematic analysis. The results were grouped into four themes: 1) conceptions of family; 2) adoption experience; 3) experiences of returning to the foster system; 4) expectations for the future. It was identified that the children idealize the nuclear and loving family, and thought of their return to the system as their own decision, although their future expectations revolve around being adopted again. It was found that the experience of adoption and subsequent return to the foster system is marked by suffering, which demands the implementation of public policies for the care of children and adolescents in this context.

Teorías subjetivas sobre el tiempo de espera y experiencias de la parentalidad adoptiva / Subjective theories about waiting time and experiences from adoptive parenting

Resumen El proceso de adopción comprende cambios importantes en las familias adoptivas, pues implica una reestructuración y adaptación a una nueva organización del sistema familiar. Durante este proceso los padres elaboran expectativas y creencias respecto a cómo comportarse frente a los cambios y adaptarse a sus hijos, desde donde dirigen sus prácticas de crianza. La percepción del tiempo que tenga cada persona posee un papel en cómo se desarrolla la identidad tanto individual como familiar, pues las experiencias pasadas, vivencias actuales y expectativas del futuro influyen en sus acciones. Por lo tanto, es posible decir que los padres adoptivos elaboran teorías subjetivas sobre este proceso y especialmente en relación con el tiempo de espera de la adopción, explicaciones que podrían incidir en la forma en que enfrentan este nuevo desafío y se preparan para la parentalidad. El presente estudio tuvo por objetivo comprender las teorías subjetivas sobre el tiempo de espera y las experiencias de la parentalidad adoptiva. Participaron diez madres y padres adoptivos mediante entrevistas episódicas individuales. Se analizaron los datos obtenidos utilizando técnicas de tres procedimientos de análisis: de contenido basado en la Teoría Fundamentada, específico para las teorías subjetivas y de la perspectiva temporal. De los hallazgos se destacan teorías subjetivas de contenido emocional ansioso durante el proceso de adopción. Además, contar con una red de apoyo, compartir experiencias con otros padres y el uso de estrategias personales son las principales estrategias de adaptación de los padres adoptivos que les permiten sobrellevar los sentimientos negativos durante el proceso.

Abstract The adoption process includes important changes in adoptive families, since it implies a restructuring and adaptation to a new organization of the family system. The path to parenthood entails changes at levels of mental, physical and social health, which in the case of adoptive parents, the challenges are greater or are altered in some way due to the unique characteristics of their experiences and the obstacles they face. To these challenges are added the usual stressors that parents face, such as changes in roles, increased stress, lack of sleep, alterations in the relationship and intimacy of the couple and difficulties that arise in raising their children. On the other hand, time is configured as a concrete dimension through which life develop. The relationship between objective time and subjective or psychological time will shape the perception of time that each person has, which has a role in how both individual and family identity develops. This is because people´s actions are influenced by past experiences, current experiences and future expectations. One of the areas of the adoption process that has not yet been deepened is the waiting time, the period of time between obtaining the suitability and assignment of the minor to the adoptive family, which can be considered important for the future family depending on how adoptive parents face it, this because the way in which the adoption process is experienced impacts both the path to parenthood and post-adoption adaptation. In fact, it confirms that waiting time influences the psychological well-being of adoptive parents. Therefore, it is possible to say that adoptive parents elaborate subjective theories about this process and especially in relation to the waiting time for adoption, explanations that could influence the way in which they face this new challenge and prepare for parenthood. The present study aimed to understand subjective theories about the waiting time and experiences of adoptive parenting. Ten adoptive mothers and fathers participated in this study through individual episodic interviews. The data obtained were analyzed using techniques of three analysis procedures: content based on Grounded Theory, specific for subjective theories and time perspective.

Reproductive plans and knowledge of assisted reproductive techniques among lesbian women: an international survey study.

OBJECTIVE: Lesbian couples must resort to adoption or donated semen to achieve parenthood, the latter usually involving assisted reproductive technology. The aim of this study is to assess homosexual women's knowledge about assisted reproductive techniques, the importance of perceived genetic and gestational relationships for their future mother-child bond, as well as their reproductive plans. METHODS: This is an observational study based on an anonymous survey disseminated online in several countries on different continents, addressed to homosexual women. RESULTS: From the 549 participants, most reported being well informed about reproductive options including assisted reproductive technology. The majority want to be a mother as part of a couple, mainly through assisted reproduction or step adoption of their partner's child. The importance of a genetic or gestational relationships with their future child varies greatly between women. Among the sampled women, pregnancy was believed to have a slightly greater impact on the future mother-child connection compared to genetics. CONCLUSIONS: Homosexual women are well informed about the assisted reproductive technology treatments. The majority considers it important to become a mother as a couple, mainly through assisted reproduction or step adoption of their partner's child. The importance given to gestation or genetic mother-child relationships varies greatly between women, and it seems they believe pregnancy may have a slightly greater impact on the future mother-child connection compared to genetics.

Clinically Indicated Genomic Sequencing of Children in Foster Care: Legal and Ethical Issues.

There are approximately 400 000 children in foster care in the US, approximately one-half of whom have chronic health problems and approximately 10% of whom have complex healthcare needs. Given the increasing relevance of genomic sequencing to guide clinical care for children with rare, chronic, and undiagnosed conditions, it may be an important component of diagnostic evaluation for children in foster care. Clinically indicated genomic sequencing may provide information that has health implications for children in foster care, as well as for their biological parents and other relatives. Whether and how genomic sequencing results impact legal decision making and family court outcomes is not yet well-understood. We describe scenarios that highlight legal, ethical, and policy issues surrounding genomic sequencing for children in foster care using 3 cases adapted from real-world events. Together, these cases highlight important yet underexplored issues that arise when genomic information has legal relevance in family court and ethical implications for child and family well-being. As genomic sequencing becomes more routine for the general pediatric population, additional research is needed to better understand its impacts on children and other stakeholders within the foster care system.

Factors for the implementation of the circular economy in Big Data environments in service companies in post pandemic times of COVID-19: The case of Colombia.

In emerging economies, Big Data (BD) analytics has become increasingly popular, particularly regarding the opportunities and expected benefits. Such analyzes have identified that the production and consumption of goods and services, while unavoidable, have proven to be unsustainable and inefficient. For this reason, the concept of the circular economy (CE) has emerged strongly as a sustainable approach that contributes to the eco-efficient use of resources. However, to develop a circular economy in DB environments, it is necessary to understand what factors influence the intention to accept its implementation. The main objective of this research was to assess the influence of attitudes, subjective norms, and perceived behavioral norms on the intention to adopt CE in BD-mediated environments. The methodology is quantitative, cross-sectional with a descriptive correlational approach, based on the theory of planned behavior and a Partial Least Squares Structural Equation Model (PLS-SEM). A total of 413 Colombian service SMEs participated in the study. The results show that managers' attitudes, subjective norms, and perceived norms of behavior positively influence the intentions of organizations to implement CB best practices. Furthermore, most organizations have positive intentions toward CE and that these intentions positively influence the adoption of DB; however, the lack of government support and cultural barriers are perceived as the main limitation for its adoption. The research leads to the conclusion that BD helps business and government develop strategies to move toward CE, and that there is a clear positive will and intent toward a more restorative and sustainable corporate strategy.

"Adoption is just not for me": How abortion patients in Michigan and New Mexico factor adoption into their pregnancy outcome decisions.

Objectives: In public discourses in the United States, adoption is often suggested as a less objectionable, equal substitute for abortion, despite this pregnancy outcome occurring much less frequently than the outcomes of abortion and parenting. This qualitative study explores whether and how abortion patients weighed adoption as part of their pregnancy decisions and, for those who did, identifies factors that contributed to their ultimate decision against adoption. Study design: We interviewed 29 abortion patients from 6 facilities in Michigan and New Mexico in 2015. We conducted a thematic analysis using both deductive and inductive approaches to describe participants' perspectives, preferences, and experiences regarding the consideration of adoption for their pregnancy. Results: Participants' reasons why adoption was not an appropriate option for their pregnancy were grounded in their ideas of the roles and responsibilities of parenting and fell into three themes. First, participants described continuing the pregnancy and giving birth as inseparable from the decision to parent. Second, choosing adoption would represent an irresponsible abnegation of parental duty. Third, adoption could put their child's safety and well-being at risk. Conclusions: Adoption was not an equally acceptable substitute for abortion among abortion patients. For them, adoption was a decision that represented taking on, and then abdicating, the role of parent. This made adoption a particularly unsuitable choice for their pregnancy. Implications: Rhetoric suggesting that adoption is an equal alternative to abortion does not reflect the experiences, preferences, or values of how abortion patients assess what options are appropriate for their pregnancy.

Family intervention in the initial adaptation of adoptive families: systematic review / Intervenção familiar na adaptação Inicial das famílias adotivas: revisão sistemática / Intervención familiar en la adaptación Inicial de las familias Adoptivas: revisión sistemática

Considering the importance of mapping family interventions practices aimed specifically to adoption, this study sought to identify through a systematic review, how family intervention models for adoptive families are structured in initial adaptation with children from 0 to 6 years old. Four databases were consulted, which led to 9.143 results: Google Scholar (n=8.056), Science Direct (n=814), SciELO (n=43) and PsycINFO (n=230). Seven articles considered pertinent to the proposal of this study were included. As a result, it was identified that most part of the interventions were not systematically described. Although promising results were indicated, replication would not be viable due to the lack of detailing of the performed practices. There was no hegemony in the choice of intervention models. Also, it was indicated that the specificity for adoption in the interventions analyzed is not clear. (AU)

Pensando na importância do mapeamento da prática de intervenção familiar voltada especificamente para a adoção, o presente estudo buscou identificar, por meio da revisão sistemática, como estão estruturados e aplicados os modelos de intervenção familiar para as famílias adotivas na adaptação inicial com as crianças de 0 a 6 anos. Para tanto, foram consultadas quatro bases de dados que levaram a 9.143 resultados: Google Scholar (n=8.056), Science Direct (n=814), SciELO (n=43), PsycINFO (n=230). Sete artigos foram considerados pertinentes à proposta deste estudo. Como resultado, identificou-se que as intervenções não estavam, em sua maioria, sistematicamente descritas. Apesar de resultados promissores serem indicados, a replicação não seria viável pela falta de detalhamentos das práticas realizadas. Ressalta-se que não houve homogeneidade na escolha dos modelos de intervenção. Por fim, destaca-se que não fica clara a especificidade voltada para adoção nas intervenções analisadas. (AU)

Pensando en la importancia de mapear la práctica de intervención familiar orientada específicamente a la adopción, el presente estudio buscó identificar, a través de una revisión sistemática, cómo se estructuran y aplican los modelos de intervención familiar para familias adoptivas en la adaptación inicial con niños de 0 a 6 años. Para ello, se consultaron cuatro bases de datos que arrojaron 9.143 resultados: Google Scholar (n=8.056), Science Direct (n=814), SciELO (n=43), PsycINFO (n=230). Siete artículos se consideraron relevantes para el propósito de este estudio. En su mayor parte, las intervenciones no se describían sistemáticamente. A pesar de los resultados prometedores, la replicación no sería factible debido a la falta de detalles de las prácticas realizadas. Cabe destacar que no hubo homogeneidad en la elección de los modelos de intervención. Por último, se señaló que no está clara la especificidad dirigida a la adopción en las intervenciones analizadas. (AU)

Health of Post-Institutionalized Haitian Children Adopted to the United States.

OBJECTIVES: Haiti remains a principal placement country for intercountry adoptees to the United States. This project reports the health status of children adopted from Haiti arriving to the U.S. and compares them to intercountry adoptees from other regions. METHODS: A retrospective chart review was conducted of adoptees placed in the U.S. from Haiti (n=87), age and sex matched with intercountry adoptees placed in the U.S. from Asia (n=87) and Latin America (n=87) between January 2010 and November 2019. Data on immunization status, contagious diseases, and nutrition and growth were analyzed via linear, logistic, and multinomial regression. RESULTS: After adjusting for age, sex, and standardized height, children adopted from Haiti, compared to adoptees from Latin America and Asia, demonstrated a lack of immunity to hepatitis B (OR=5.89;6.87), increased immunity to hepatitis A (OR=0.38;0.30), infection by two or more parasites (OR=8.43;38.48), high lead levels (OR=23.79;7.04), and anemia (OR=15.25;9.18). Unexpectedly, children adopted from Haiti had greater standardized height (-1.28 vs. -1.82 and -2.13) and standardized weight (-0.32 vs. -0.57 and -1.57) than their counterparts from Latin America and Asia. CONCLUSIONS: Children adopted from Haiti face complex medical challenges undoubtedly related to the country's low socioeconomic status (SES) and the impact of recurrent natural disasters and governmental neglect on public health infrastructure. Appropriate care is critical in preventing and avoiding transmission of infectious diseases in adoptees and family members. The high incidence of anemia and elevated lead levels may further exacerbate the developmental effects of early institutional deprivation.