Pintura Mural para Recolectar Datos Sensibilizantes y Fomentar la Participación en la Investigación Entre los Latinos de EE. UU.

Proposito. Describir una intervención de murales implementadas con comunidad envecindarios Latinos para elevar conciencia de barreras delreclutamiento/retención de Latinos en EE. UU. en la investigación clínica,y aumentar acceso de los investigadores a conceptos de sensibilización críticos para el riguroso diseño de estudios. Fondo. Latinos en EE. UU. sufren desproporcionada de varias enfermedadescrónicas, pero son subrepresentados como investigadores y participantesen investigaciones financiadas por Institutos Nacionales de Salud. Faltade representación inhibe conciencia de necesidades Latinas para la saludy obstaculiza esfuerzos para abordar la falta de equidad en comunidadesdiversas. Las intervenciones de arte en comunidades Latinas siguensiendo reconocidas por capacidad a cerrar brechas e incrementar lacalidad y cantidad de asociaciones de investigación entre investigadores y Latinos. Método. Este artículo describe una intervención de murales puesta a prueba endos vecindarios mayormente Latinos entre 2016 y 2020. El método deldiseño fue guiado por prácticas de investigación participativas con lacomunidad enfocadas en Evaluación-Diagnóstico Planificación- Implementación-Evaluación. Resultados. Los murales abordaron muchos desafíos de participación que a menudo se asocian con la subrepresentación de los Latinos en la investigación académica y permitió entrevistas de sensibilización con miembros clave de la comunidad sobre temas de interés para investigación. Conclusión. Los métodos de investigación que reconocen las formas de arte tradicionales, como murales, crean espacio para generar confianza e iniciar interés en la participación en investigaciones, y aumentan acceso.

Differentiating competency from content: Parental racial socialization profiles and their associated factors.

For Black parents, the racial socialization (RS) process represents a critical parenting practice. Although the field has historically focused on the content of parents' RS, it is also important to consider caregivers' perception of their competence to effectively teach their children to navigate their racialized world. The present study investigated patterns of RS by exploring 332 Black caregivers' report of both content and competency. Using Latent Profile Analysis (LPA), we identified three profiles of RS: Multifaceted & More Competent (MMC), Unengaged & Moderately Competent (UModC), and Negative, Stressed, & Less Competent (NSLC). Additionally, we explored the role of several previously established correlates of parental RS, including sociodemographic factors (i.e., age, gender, and socioeconomic status), caregiving status (e.g., mother, father, and aunt), and parents' race-related experiences (i.e., history of RS, racial identity, and experiences with racial discrimination). Generally, the NSLC profile consisted of caregivers who were younger than those in the other two profiles, while those in the UModC profile tended to have younger children, relatively. Interestingly, caregivers in the UmodC profile reported receiving significantly less RS in childhood and experienced less racial discrimination than those in the other two profiles. Numerous differences were found across profiles for dimensions of racial identity. The emergence of these varied profiles, as well as the identification of factors that differentiated them, extends our understanding of RS and highlights the importance of considering parents' notions of feeling confident, skillful, and less stressed as they navigate such a vital developmental process for their children.

Para los padres negros, el proceso de socialización racial (SR) representa una práctica fundamental de crianza. Aunque esta área históricamente se ha centrado en el contenido de la SR de los padres, también es importante tener en cuenta la percepción que tienen los cuidadores de su competencia para enseñarles eficazmente a sus hijos a orientarse en su mundo racializado. En el presente estudio se investigaron los patrones de SR analizando el informe de 332 cuidadores negros sobre contenido y competencia. Utilizando el análisis de perfiles latentes (APL), identificamos tres perfiles de SR: polifacéticos y más competentes (PMC), no comprometidos y moderadamente competentes (NCModC) y negativos, menos competentes y estresados (NMCE). Además, analizamos el papel que juegan varias correlaciones de SR de los padres previamente establecidas, incluidos los factores sociodemográficos, (p. ej., la edad, el género y la situación socioeconómica), la situación de cuidado (p. ej.: la madre, el padre, la tía) y las experiencias de los padres relacionadas con la raza (p. ej., los antecedentes de SR, la identidad racial, y las experiencias con la discriminación racial). Generalmente, el perfil NMCE estuvo compuesto por cuidadores que eran más jóvenes que los de los otros dos perfiles, mientras que los del perfil NCModC fueron propensos a tener hijos más pequeños, relativamente. De modo interesante, los cuidadores del perfil NCModC informaron haber recibido una SR considerablemente menor en la niñez y sufrieron menos discriminación racial que los de los otros dos perfiles. Se encontraron numerosas diferencias entre los perfiles con respecto a las dimensiones de identidad racial. El surgimiento de estos perfiles variados, así como la identificación de los factores que los diferenciaron, amplían nuestra comprensión de la SR y destacan la importancia de tener en cuenta las intenciones de los padres de sentirse seguros, habilidosos y menos estresados a medida que transitan este proceso tan fundamental del desarrollo para sus hijos.

Parent-to-child aggression, intimate partner aggression, conflict resolution, and children's social-emotional competence in early childhood.

Early childhood is critical to the development of children's social-emotional competence, which predicts peer relations and school adjustment in later periods of childhood. The effects of experiencing or witnessing aggression on children's social-emotional development are well known, yet the role of conflict resolution within the family has not been sufficiently studied. Social information processing models suggests that children who experience positive forms of conflict resolution within the family are likely to generalize these experiences and related skills outside the family, and thus develop greater social-emotional competence. In this longitudinal study, 128 parents (representing 79 families) participated in four quarterly telephone interviews in which they described aggressive conflicts that occurred in their family for which their children were present, including the degree to which each conflict was resolved. They also reported on the frequency of intimate partner aggression (IPA) and parent-to-child aggression (PCA) that occurred while the child was in toddlerhood and preschool as well as children's social-emotional competence at the end of the study. Multi-level models reveal that parents' reports of positive conflict resolution mitigated the concurrent and longitudinal negative effects of children's exposure to both IPA and PCA on their social-emotional competence. These findings reinforce prevention scientists' emphasis on conflict resolution skills as an essential component of parent education programs.

La primera infancia es fundamental para el desarrollo de la competencia socioemocional de los niños, la cual predice las relaciones entre pares y la adaptación escolar en periodos posteriores de la niñez. Se conocen muy bien los efectos que producen el sufrir o ser testigos de agresión en el desarrollo socioemocional de los niños, sin embargo, aún no se ha estudiado de manera suficiente el papel que desempeña la resolución de conflictos dentro de la familia. Los modelos de procesamiento de la información social sugieren que los niños que viven formas positivas de resolución de conflictos dentro de la familia son propensos a generalizar estas experiencias y las habilidades afines fuera de la familia y, por lo tanto, a desarrollar una mayor competencia socioemocional. En este estudio longitudinal, 128 padres (que representaban 79 familias) participaron en cuatro entrevistas telefónicas cada tres meses en las cuales describieron conflictos agresivos que hubo en su familia en los cuales sus hijos estuvieron presentes, incluido el grado en el cual se resolvió cada conflicto. También informaron la frecuencia de agresión en la pareja y de agresión de padres a hijos que tuvo lugar durante sus primeros años de vida y en la etapa del preescolar, así como la competencia socioemocional de los niños al final del estudio. Los modelos multinivel indican que los informes de los padres sobre la resolución positiva de los conflictos mitigaron los efectos negativos longitudinales y simultáneos de la exposición de los niños a la agresión en la pareja y a la agresión de padres a hijos en su competencia socioemocional. Estos resultados refuerzan el énfasis en las habilidades de resolución de conflictos de los científicos de la prevención como componente esencial de los programas de educación para padres.

Maternal-fetal attachment, parenting stress during infancy, and child outcomes at age 3 years.

Maternal-fetal attachment (MFA), a woman's relationship with and affiliative behaviors toward her unborn child, has been linked to near-term infant physical and developmental outcomes. However, further longitudinal research is needed to understand whether the impact of MFA extends past the earliest years of life. The current study explored relationships between MFA and child socioemotional competence and behavior problems at age 3 and whether parenting stress mediated the association between MFA and child outcomes. Data were collected from 221 primarily Black/African-American mothers who completed a scale of MFA during pregnancy. Mothers reported on parenting stress at infant age 7 months and reported on child socioemotional competence and problem behaviors at child age 3 years. In path analyses, MFA was directly associated with child socioemotional competence at age 3 years, but an indirect association between MFA and socioemotional competence via parenting stress was not significant. We also observed a significant indirect association between lower MFA and child internalizing behavior problems via parenting stress that was related to maternal dissatisfaction regarding interactions with her child. Findings suggest that assessing MFA may serve as a means to identify dyads who would benefit from support to promote individual health outcomes.

La afectividad materno-fetal (MFA), la relación y comportamientos de afiliación de una mujer hacia su niño en el vientre, ha sido conectada a los resultados físicos y de desarrollo del infante cuya gestación está cerca al término. Sin embargo, se necesita investigación longitudinal adicional para comprender si el impacto de MFA se extiende más allá de los más tempranos años de vida. El presente estudio exploró las relaciones entre MFA y la competencia socioemocional y problemas de comportamiento del niño a la edad de 3 años y si el estrés de crianza medió la asociación entre MFA y los resultados en el niño. Se recogió información de 221 madres, primariamente negras/afroamericanas, que completaron una escala de MFA durante el embarazo. Las madres reportaron sobre el estrés de crianza cuando el infante tenía 7 meses y reportaron sobre la competencia socioemocional y los problemas de comportamiento del niño cuando éste tenía 3 años. En análisis de trayectoria, se asoció MFA directamente con la competencia socioemocional del niño a la edad de 3 años, pero una asociación indirecta entre MFA y la competencia socioemocional por medio del estrés de crianza no fue significativa. También observamos una significativa asociación indirecta entre MFA y la internalización de problemas del comportamiento por parte del niño vía el estrés de crianza que se relacionó con la insatisfacción materna en cuanto a las interacciones con su niño. Los resultados indican que evaluar MFA pudiera servir como un medio de identificar díadas que se beneficiarían del apoyo para promover resultados de salud individuales.

L'attachement maternel foetal (Maternal-fetal attachment, soit MFA), une relation de la femme avec son enfant à naître et des comportements affiliatifs envers l'enfant à naître, a été lié à des résultats physiques et développementaux du bébé quasiment à terme. Cependant des recherches longitudinales plus approfondies sont nécessaires afin de comprendre si l'impact du MFA dépasse les premières années de la vie. Cette étude a exploré les relations entre le MFA et la compétence socio-émotionnelle de l'enfant et les problèmes de comportement à l'âge de trois ans et si le stress de parentage affectait l'association entre le MFA et les résultats sur l'enfant. Les données ont été recueillies à partir de 221 mères américaines majoritairement noires/afro-américaines qui ont rempli l'échelle du MFA durant la grossesse. Les mères ont fait état de stress de parentage à l'âge de 7 mois pour le bébé et répondu à des questions sur la compétence socio-émotionnelle de l'enfant et les problèmes de comportement à l'âge de 3 ans. Dans les analyses de trajectoire le MFA était directement lié à la compétence socio-émotionnelle de l'enfant à l'âge de 3 ans, mais un lien indirect entre le MFA et la compétence socio-émotionnelle à travers le stress de parentage n'était pas important. Nous avons aussi observé un lien indirect important entre le MFA et les problèmes de comportement d'internalisation de l'enfant au travers du stress de parentage qui était lié à l'insatisfaction maternelle concernant les interactions avec son enfant. Les résultats suggèrent que l'évaluation du MFA peut servir de moyen d'identifier des dyades qui bénéficierait d'un soutien pour promouvoir des résultats de santé individuels.

[Adaptation and validation of an instrument to evaluate the competence on a Brief Tobacco Intervention. BTI-Prof©]. / Adaptación y validación de un instrumento de evaluación de la competencia del consejo breve para dejar de fumar. BTI-Prof©.

OBJECTIVE: Adaptation and validation of the BTI-St© to assess the level of competence in brief tobacco intervention in general practitioners and nurses in Primary Health Care. DESIGN: Cross-sectional study of adaptation and psychometric validation of a criterion-referenced test. SETTING: Primary Health Care. PARTICIPANTS: One hundred fifty-five general practitioners and nurses working at Primary Health Care. INTERVENTIONS: Three clinical scenarios were designed. Using an online platform, participants first viewed each scenario in which brief tobacco intervention was given. Health professional had to assess whether or not the scenarios were carried out in accordance with the 5A+5R model. MAIN MEASURES: Competence in brief tobacco intervention measured by the BTI-Prof©. RESULTS: Results related to reliability were obtained through Kuder-Richardson coefficient, being for scenario 1, 0.880, for scenario 2, 0.829, and for scenario 3, 0.826. The test-retest shows adequate temporal stability: intraclass correlation coefficient for scenario 1 0.857 (95% CI 0.734-0.923), p<0.0001, for scenario 2 0.829 (95% CI 0.676-0.909), p<0.001, and for scenario 3 0.869 (95% CI 0.76-0.928), p<0.0001. CONCLUSIONS: The BTI-Prof© is a robust tool with adequate psychometric properties to assess competence in brief tobacco intervention in Primary Health Care general practitioners and nurses.

Effects of High- versus Low-Intensity Clinician Training on Implementation of Family-Focused Therapy for Youth with Mood and Psychotic Disorders.

The implementation of evidence-based psychotherapies often requires significant commitments of time and expense from mental health providers. Psychotherapy protocols with rapid and efficient training and supervision requirements may have higher levels of uptake in publicly funded clinics. Family-focused therapy (FFT) is a 4-month, 12-session treatment for bipolar and psychosis patients consisting of psychoeducation, communication training, and problem-solving skills training. In a pilot randomized trial, we compared two methods of training community clinicians in FFT: (a) high intensity (n = 24), consisting of a 6-hour in-person didactic workshop followed by telephone supervision for every session with training cases; or (b) low-intensity training (n = 23), consisting of a 4-hour online workshop covering the same material as the in-person workshop followed by telephone supervision after every third session with training cases. Of 47 clinician participants, 18 (11 randomly assigned to high intensity, 7 to low) enrolled 34 patients with mood or psychotic disorders (mean age 16.5 ± 2.0 years; 44.1% female) in an FFT implementation phase. Expert supervisors rated clinicians' fidelity to the FFT manual based on taped family sessions. We detected no differences in fidelity scores between clinicians in the two training conditions, nor did patients treated by clinicians in high- versus low-intensity training differ in end-of-treatment depression or mania symptoms. Levels of parent/offspring conflict improved in both conditions. Although based on a pilot study, the results suggest that low-intensity training of community clinicians in FFT is feasible and can result in rapid achievement of fidelity benchmarks without apparent loss of treatment efficacy.

La implementación de psicoterapias factuales generalmente exige compromisos significativos de tiempo y gastos por parte de los profesionales de salud mental. Los protocolos de psicoterapia con los requisitos de capacitación y supervisión rápidas y eficaces pueden tener niveles más altos de captación en las clínicas financiadas con fondos públicos. La terapia centrada en la familia es un tratamiento de 4 meses y 12 sesiones para pacientes bipolares y con psicosis que consiste en psicoeducación, capacitación en comunicación y capacitación en habilidades de resolución de problemas. En un ensayo aleatorizado piloto, comparamos dos métodos de capacitar a profesionales clínicos de la comunidad en terapia centrada en la familia: (a) la capacitación de alta intensidad (n = 24), que consiste en un taller didáctico presencial de seis horas seguido de supervisión telefónica para cada sesión con casos de capacitación; o (b) la capacitación de baja intensidad (n=23), que consiste en un taller virtual de cuatro horas y cubre el mismo material que el taller presencial seguido de supervisión telefónica después de cada tercera sesión con casos de capacitación. De 47 profesionales clínicos participantes, 18 (11 asignados aleatoriamente a alta intensidad, y 7 a baja intensidad) inscribieron a 34 pacientes con trastornos del estado de ánimo o psicóticos (edad promedio 16.5+2.0 años; el 44.1 % mujeres) en una fase de implementación de la terapia centrada en la familia. Un grupo de supervisores expertos calificó la fidelidad de los profesionales clínicos al manual de la terapia centrada en la familia basándose en sesiones familiares grabadas. No detectamos diferencias en los puntajes de fidelidad entre los profesionales clínicos de las dos condiciones de capacitación, ni los pacientes tratados por profesionales clínicos en las capacitaciones de alta intensidad ni en las de baja intensidad tuvieron diferencias en los síntomas de manía o depresión al final del tratamiento. Los niveles de conflicto entre los padres y los hijos mejoraron en ambas condiciones. Aunque están basados en un estudio piloto, los resultados sugieren que la capacitación de baja intensidad de los profesionales clínicos de la comunidad en la terapia centrada en la familia es viable y puede dar como resultado un logro rápido de referentes de fidelidad sin pérdida aparente de eficacia del tratamiento.

Reflections on our efforts to help mental health agencies become more "culturally competent".

This paper reflects on our decades-long cultural training experiences, offering details on training efforts we made and considers in hindsight interventions we wish we had been able to implement. The paper describes what we think could be necessary for organizational training/consultation to facilitate the transformation of organizations in the direction of social justice and the delivery of efficient and effective services to a community. We reflect on organizational training to promote cultural competence and social justice. We encourage readers to take the broadest possible perspective on the larger systems issues that tend to undermine such efforts, so they can better achieve their goals for organizational change.

En este artículo reflexionamos sobre nuestras experiencias de capacitación cultural desde hace décadas, ofrecemos detalles sobre los esfuerzos de capacitación que hicimos y tenemos en cuenta las intervenciones posteriores que hubiéramos querido implementar y no pudimos. También describimos lo que consideramos que podría ser necesario para que la consulta/capacitación organizativa facilite la transformación de las organizaciones en dirección de la justicia social y la prestación de servicios eficaces y efectivos para una comunidad. Reflexionamos sobre la capacitación organizativa para promover la competencia cultural y la justicia social. Animamos a los lectores a adoptar la perspectiva más amplia posible con respecto a los problemas de los sistemas más grandes que tienden a socavar dichos esfuerzos, de manera que puedan lograr mejor sus objetivos para el cambio organizativo.

Interparental Hostility Interacts with Interparental Cooperative Conflict to Predict Adolescent Social Competence Through Parent-Child Relationship Quality.

An emerging (yet still scant) body of research has linked interparental hostility to youth compromised social competence over time among adolescents. Moreover, little is known about the conditions under which and the processes through which this association might occur. Using prospective data from 878 youth (50.23% females) and their parents and teachers, this study examined how interparental hostility and cooperative conflict might work in conjunction with each other to predict youth social competence over time via parent-child relationship quality. Results demonstrated that interparental cooperative conflict at grade 5 buffered the negative association between interparental hostility at grade 5 and mother-child but not father-child relationship quality at grade 6. Mother-child relationship quality, in turn, was associated positively with youth social competence at age 15. As such, interparental hostility at grade 5 was negatively related to youth social competence at age 15 via mother-child relationship quality at grade 6 only when interparental cooperative conflict at grade 5 was low. This study represents a more nuanced and specific examination of the implications of interparental hostility for child later social development by highlighting underlying moderating and mediating mechanisms. Relevant implications for the development of more targeted and effective interventions are also discussed.

Un número cada vez mayor (aunque aún escaso) de investigaciones han vinculado la hostilidad interparental con la competencia social comprometida de los jóvenes conforme avanza el tiempo entre adolescentes. Además, se sabe poco acerca de las condiciones en las cuales podría producirse esta asociación, así como acerca de los procesos por los cuales podría producirse. Utilizando datos prospectivos de 878 jóvenes (el 50.23 % de sexo femenino) y de sus padres y maestros, este estudio analizó cómo la hostilidad interparental y el conflicto cooperativo podrían funcionar en conjunto para predecir la competencia social de los jóvenes conforme avanza el tiempo mediante la calidad de la relación entre padres e hijos. Los resultados demostraron que el conflicto cooperativo interparental en el grado 5 amortiguó la asociación negativa entre la hostilidad interparental en el grado 5 y una menor calidad de la relación entre madre e hijo, pero no entre padre e hijo, en el grado 6. La calidad de la relación entre madre e hijo, a su vez, estuvo asociada positivamente con la competencia social de los jóvenes a los 15 años. Como tal, la hostilidad interparental en el grado 5 estuvo asociada negativamente con la competencia social de los jóvenes a los 15 años mediante la calidad de la relación entre madre e hijo en el grado 6 solo cuando el conflicto cooperativo interparental en el grado 5 fue bajo. Este estudio representa un análisis más matizado y específico de las implicancias de la hostilidad interparental para el desarrollo social posterior de los niños destacando un posible factor moderador y mecanismo de mediación. Se debaten algunas implicancias relevantes para el desarrollo de intervenciones más dirigidas y eficaces.

[Impact of training on Motivational Interviewing (MI) for Family Physicians: Design and assessment of a Training Program (MOTIVA)]. / Impacto de la formación en entrevista motivacional para médicos: diseño y evaluación de un Programa Formativo (MOTIVA).

AIM: To develop a training program in Motivational Interviewing for Family Physicians and assess the impact. STUDY DESIGN: Multicenter, double blind and randomized clinical essay, with 2arms, Experimental (EG) and Control (CG) of Family Physicians with a follow up of 12 months. LOCATION: 32 Primary Healthcare Centers. SAMPLE DESCRIPTION: 54 physicians (CG=28, EG=26). INTERVENTIONS: Training Program MOTIVA in ME with an initial presential course (16h), followed by online activities during 12months, and presential meetings (Problem BasedInterviewing with expert feedback). MAIN MEASUREMENTS: Communicative skills in MI were assessed based on video-recordings (VR) with the EVEM 2.0 scale by peer reviewers. 236 VR with standardized patients and 96 VR with real patients. RESULTS: Average results in EVEM scale (up to 56 points) at the beginning of the study were EG=21.27 (CI 95% 15.8-26.7) and CG=20.23 (CI95% 16.4-23.9) with no differences between both groups (P=.79). After the training, EG punctuation increased by 13.89 points (P<.001), average 35.16 (CI 95% 29.8-40.6). Real patients' VR in EG over a 12 month period keep their MI skills with an average of 36.9 points (CI 95% 30.3-43.6) versus CG 15.9 points (CI 95% 9.8-22.0). Once ended the MOTIVA Training Program, the EG maintains the acquired skills: final average EG=37.6 (CI 95% 33.2-41.1) versus CG=24.3 (CI95% 19.0-29.2) (P<.001). CONCLUSIONS: The MOTIVA Training Program improves Motivational Interviewing skills, significatively improving after a presential course and sequential keep-alive activities. The effectiveness of the Program has been proven in the Third and Fourth steps of Miller's Pyramid.

[Evidence-Based Practice competency and associated factors among Primary Care nurses in Spain]. / Competencia en Práctica Basada en la Evidencia y factores asociados en las enfermeras de Atención Primaria en España.

OBJECTIVE: To describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors. DESIGN: Cross-sectional, national survey design, carried out between January and March 2020. SETTING: PC in Spain. PARTICIPANTS: Seven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience. MAIN MEASUREMENTS: (1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out. RESULTS: The mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization. CONCLUSIONS: These findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results.

Design, assembly and validation of a low-cost, high-fidelity simulator for heart exploration.

INTRODUCTION: Heart exploration is an essential clinical competence that requires continuous training and exposure. Low availability and accessibility to patients with heart disease constitutes a barrier to acquiring this competence. Inadequate cardiac auscultation skills in medical students, residents, and graduate physicians have been documented. OBJECTIVE: To develop and validate a low-cost, high-fidelity simulator for heart exploration. METHODS: A low-cost, high-fidelity heart examination simulator capable of reproducing normal cardiac sounds was designed and developed. Subsequently, the simulator was validated by a group of experts who gave their opinion according to a Likert scale. RESULTS: Ninety-four percent agreed that the simulator motivates the learning of heart exploration, and 92 % considered it to be a realistic model; 91 % considered that the simulator is an attractive tool to reinforce learning and 98 % recommended its further use. CONCLUSIONS: The use of the simulator facilitates the acquisition of skills and stimulates learning in the student, which can be attributed to repeated practice, longer exposure time and cognitive interaction.

INTRODUCCIÓN: La exploración cardiaca es una competencia clínica fundamental que requiere exposición o entrenamiento continuo. La baja disponibilidad y accesibilidad de pacientes con patología cardiaca constituye una barrera para adquirir esta competencia. Se han documentado inadecuadas habilidades de auscultación cardiaca en estudiantes de medicina, residentes y médicos graduados. OBJETIVO: Elaborar y validar un simulador de alta fidelidad y bajo costo para exploración cardiaca. MÉTODOS: Se diseñó y elaboró un simulador para exploración cardiaca, realista y de bajo costo capaz de reproducir ruidos cardiacos normales. Posteriormente se realizó la validación del simulador por un grupo de expertos que emitieron su opinión de acuerdo con una escala tipo Likert. RESULTADOS: El 94 % afirmó que el simulador motiva el aprendizaje de la exploración cardiaca y 92 % lo consideró un modelo realista; 91 % consideró que el simulador es una herramienta atractiva para fortalecer el aprendizaje y 98 % recomendó seguir utilizándolo. CONCLUSIONES: El uso del simulador facilita la adquisición de competencias y estimula el aprendizaje en el estudiante, lo cual puede ser atribuido a la práctica deliberada, a un mayor tiempo de exposición y a la interacción cognitiva.

Perceived Collective Efficacy and Parenting Competence: The Roles of Quality of Life and Hope.

Parents' perceptions of their parenting competence predict successful implementation of parenting tasks and contribute to their interest and involvement in parenting and to their children's development. Thus, identifying factors that contribute to parents' perceptions of parenting competence can help inform efforts to promote children's safety and well-being. The present study employs social disorganization theory to examine the relationship between collective efficacy and parents' sense of competence, measured along two dimensions: parental efficacy and parental satisfaction. It examines the direct association between the two constructs and whether the association is mediated by parent perceptions of their quality of life (QOL) and sense of hope. Data were collected from 198 parents residing in a neighborhood in southern Tel Aviv, Israel. The analyses indicated that high collective efficacy was directly associated with high parental efficacy, but not with high parental satisfaction. Using structural equation modeling, a mediation model was found whereby higher collective efficacy was associated with (a) higher QOL, which in turn was related to a greater sense of hope, which was linked with higher parental efficacy; and (b) higher QOL, which was directly associated with higher parental satisfaction. The findings provide further support to the idea that neighborhood characteristics play an important role in parents' ability to care for their children.

Las percepciones de los padres de su competencia en la crianza predicen la implementación satisfactoria de las tareas de crianza y contribuyen a su interés y participación en la crianza y al desarrollo de sus hijos. Por ende, los factores identificadores que contribuyen a las percepciones de los padres de su competencia en la crianza pueden ayudar a orientar las iniciativas para promover la seguridad y el bienestar de los niños. El presente estudio emplea la teoría de la desorganización social a fin de analizar la relación entre la eficacia colectiva y la percepción de competencia de los padres evaluadas en dos dimensiones: la eficacia parental y la satisfacción parental. Además, examina la asociación directa entre los dos constructos y si la asociación está mediada por las percepciones de los padres de su calidad de vida y su sensación de esperanza. Se recopilaron datos de 198 padres que viven en un barrio del sur de Tel Aviv, Israel. Los análisis indicaron que una eficacia colectiva alta estuvo directamente asociada con una eficacia parental alta, pero no con una satisfacción parental alta. Utilizando modelos de ecuaciones estructurales, se descubrió un modelo de mediación por el cual una eficacia colectiva más alta estuvo asociada con (a) una calidad de vida más alta, la cual a su vez estuvo relacionada con una mayor sensación de esperanza, que estuvo ligada con una eficacia parental más alta; y (b) una calidad de vida más alta, que estuvo directamente asociada con una satisfacción parental más alta. Los resultados ofrecen mayor respaldo de la idea de que las características de un barrio desempeñan un papel importante en la capacidad de los padres para preocuparse por sus hijos.

Applying deep learning to right whale photo identification.

Photo identification is an important tool for estimating abundance and monitoring population trends over time. However, manually matching photographs to known individuals is time-consuming. Motivated by recent developments in image recognition, we hosted a data science challenge on the crowdsourcing platform Kaggle to automate the identification of endangered North Atlantic right whales (Eubalaena glacialis). The winning solution automatically identified individual whales with 87% accuracy with a series of convolutional neural networks to identify the region of interest on an image, rotate, crop, and create standardized photographs of uniform size and orientation and then identify the correct individual whale from these passport-like photographs. Recent advances in deep learning coupled with this fully automated workflow have yielded impressive results and have the potential to revolutionize traditional methods for the collection of data on the abundance and distribution of wild populations. Presenting these results to a broad audience should further bridge the gap between the data science and conservation science communities.

Aplicación del Aprendizaje Profundo a la Identificación Fotográfica de la Ballena Franca Resumen La identificación fotográfica es una herramienta importante para la estimación de la abundancia y el monitoreo de las tendencias poblacionales en el tiempo. Sin embargo, corresponder las fotografías con los individuos conocidos requiere de mucho tiempo. Motivados por los avances recientes en el reconocimiento de imágenes, decidimos acoger un reto de datos científicos en la plataforma de colaboración masiva Kaggle para automatizar la identificación de ballenas francas del Atlántico norte (Eubalaena glacialis), especie que se encuentra en peligro de extinción. La solución ganadora identificó automáticamente a las ballenas individuales con una certeza del 87% y con una serie de redes neurales convolucionales para identificar la región de interés en una imagen, rotar, recortar, y crear fotografías estandarizadas de tamaño y orientación uniforme y después identificar al individuo correcto a partir de estas fotografías tamaño pasaporte. Los avances recientes en el aprendizaje profundo acoplados a este flujo de trabajo completamente automatizado han producido resultados impresionantes y tienen el potencial para revolucionar los métodos tradicionales de recolección de datos de abundancia y distribución de las poblaciones silvestres. La presentación de estos resultados ante un público amplio debería reducir aún más el vacío que existe entre los datos científicos y las comunidades científicas para la conservación.

The Effects of Mother Participation in Relationship Education on Coparenting, Parenting, and Child Social Competence: Modeling Spillover Effects for Low-Income Minority Preschool Children.

Although suggestions are that benefits of relationship and marriage education (RME) participation extend from the interparental relationship with parenting and child outcomes, few evaluation studies of RME test these assumptions and the relationship among changes in these areas. This quasi-experimental study focuses on a parallel process growth model that tests a spillover hypothesis of program effects and finds, in a sample of low-income minority mothers with a child attending a Head Start program, that increases in mother reports of coparenting agreement for RME participants predict decreases in their reports of punitive parenting behaviors. Although improvements in parenting behaviors did not predict increases in teacher reports of children's social competence, improvements in coparenting agreement were associated with increases in children's social competence over time. In addition, comparative tests of outcomes between parents in the program and parents in a comparison group reveal that RME program participants (n = 171) demonstrate significant improvements compared to nonparticipants (n = 143) on coparenting agreement, parenting practices, and teachers' reports of preschool children's social competence over a 1 year period. The findings are offered as a step forward in better understanding the experiences of low-resource participants in RME. Implications for future research are discussed.

Reservoir-host amplification of disease impact in an endangered amphibian.

Emerging wildlife pathogens are an increasing threat to biodiversity. One of the most serious wildlife diseases is chytridiomycosis, caused by the fungal pathogen, Batrachochytrium dendrobatidis (Bd), which has been documented in over 500 amphibian species. Amphibians vary greatly in their susceptibility to Bd; some species tolerate infection, whereas others experience rapid mortality. Reservoir hosts-species that carry infection while maintaining high abundance but are rarely killed by disease-can increase extinction risk in highly susceptible, sympatric species. However, whether reservoir hosts amplify Bd in declining amphibian species has not been examined. We investigated the role of reservoir hosts in the decline of the threatened northern corroboree frog (Pseudophryne pengilleyi) in an amphibian community in southeastern Australia. In the laboratory, we characterized the response of a potential reservoir host, the (nondeclining) common eastern froglet (Crinia signifera), to Bd infection. In the field, we conducted frog abundance surveys and Bd sampling for both P. pengilleyi and C. signifera. We built multinomial logistic regression models to test whether Crinia signifera and environmental factors were associated with P. pengilleyi decline. C. signifera was a reservoir host for Bd. In the laboratory, many individuals maintained intense infections (>1000 zoospore equivalents) over 12 weeks without mortality, and 79% of individuals sampled in the wild also carried infections. The presence of C. signifera at a site was strongly associated with increased Bd prevalence in sympatric P. pengilleyi. Consistent with disease amplification by a reservoir host, P. pengilleyi declined at sites with high C. signifera abundance. Our results suggest that when reservoir hosts are present, population declines of susceptible species may continue long after the initial emergence of Bd, highlighting an urgent need to assess extinction risk in remnant populations of other declined amphibian species.

Acculturation Conflict, Cultural Parenting Self-Efficacy, and Perceived Parenting Competence in Asian American and Latino/a Families.

Parents from immigrant backgrounds must deal with normative parenting demands as well as unique challenges associated with acculturation processes. The current study examines the independent and interactive influences of acculturation conflict and cultural parenting self-efficacy (PSE; e.g., parents' confidence in instilling heritage, American, and bicultural values in their children) on perceptions of general parenting competence. Using data from 58 Asian American and 153 Latin American parents of children in grades 6-12, ethnic differences were also explored. Results suggest that lower acculturation conflict is associated with higher perceptions of general parenting competence for both Asian and Latin American parents. Higher cultural PSE is associated with higher perceived general parenting competence for Latino/a parents only. One significant interaction was found, and only for Asian Americans, whereby the negative association between acculturation conflict and perceptions of parenting competence was weaker for those who felt efficacious in transmitting heritage messages. Results are discussed in light of clinical implications and the need for further recognition and study of culturally relevant factors and frameworks among families from immigrant backgrounds.

[Application of the cultural competence model in the experience of care in nursing professionals Primary Care]. / La aplicación del modelo de competencia cultural en la experiencia del cuidado en profesionales de Enfermería de Atención Primaria.

OBJECTIVE: To know the experiences and perceptions of nurses in providing care and health promotion, women belonging to groups at risk of social vulnerability, applying the model of cultural competence Purnell. DESIGN: Phenomenological qualitative study. LOCATION: Department of Health Elda. PARTICIPANTS: A total of 22 primary care professional volunteers. METHOD: Semi-structured interviews and focus groups with recording and content analysis, according to the theory model of cultural competence. RESULTS: Socio-cultural factors influence the relationship between professionals and users of the system. The subtle racism and historical prejudices create uncomfortable situations and mistrust. The language barrier makes it difficult not only communication, but also the monitoring and control of the health-disease process. The physical appearance and stereotypes are determining factors for primary care professionals. Although perceived misuse of health services are also talking about changes. The spiritual aspects of religious beliefs alone are taken into account in the case of Muslim women, not being considered as important in the case of Gypsy women and Romanian women. CONCLUSIONS: To provide quality care, consistent and culturally competent, it is necessary to develop training programs for professionals in cultural competence, to know the culture of other, and work without preconceived ideas, and ethnocentric; since the greater the knowledge of the cultural group being served, the better the quality of care provided.

MOMENTS OF MEETING: THE RELEVANCE OF LOU SANDER'S AND DAN STERN'S CONCEPTUAL FRAMEWORK FOR UNDERSTANDING THE DEVELOPMENT OF PATHOLOGICAL SOCIAL RELATEDNESS.

Lou Sander and Dan Stern made seminal contributions to our understanding of early child development, particularly in regard to the moment-to-moment intersubjective exchanges and mutual sensitivity that are at the core of the caregiver-infant relationship. Although their own studies focused primarily on the ways in which children's intersubjective experiences of mutual attunement lead to adaptive social relatedness and validate a healthy sense of self, this article focuses on the applicability of their theoretical conceptions to the development of pathological social relations. It explores the premise that the emotional validation derived from recurrent intersubjective experiences of mutual attunement involving negative affects can be as emotionally compelling from the child's standpoint as that derived from positive exchanges. Children's needs to recreate unhealthy, but affectively meaningful, moments with their caregivers can lead to ingrained, automatically operating pathological patterns of social behavior and affective expression that can take on a life of their own and strongly shape the child's subsequent socioemotional functioning. Following an overview of Sander's and Stern's conceptual thinking, developmental research and clinical case material will be utilized to illustrate how their work can enrich our understanding of developmental processes that can contribute to a number of emotion-specific, early relational disturbances.

[The Use of the Objective Structured Clinical Examination for Paediatric residents in the City of Buenos Aires]. / Aplicación del Examen Clínico Objetivo Estructurado en la residencia de Pediatría de la Ciudad de Buenos Aires.

INTRODUCTION: The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. SUBJECTS AND METHOD: Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. RESULTS: Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR=1.4; 95% CI 0.4-5.5; P=.8). CONCLUSIONS: In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them.

Pollution, habitat loss, fishing, and climate change as critical threats to penguins.

Cumulative human impacts across the world's oceans are considerable. We therefore examined a single model taxonomic group, the penguins (Spheniscidae), to explore how marine species and communities might be at risk of decline or extinction in the southern hemisphere. We sought to determine the most important threats to penguins and to suggest means to mitigate these threats. Our review has relevance to other taxonomic groups in the southern hemisphere and in northern latitudes, where human impacts are greater. Our review was based on an expert assessment and literature review of all 18 penguin species; 49 scientists contributed to the process. For each penguin species, we considered their range and distribution, population trends, and main anthropogenic threats over the past approximately 250 years. These threats were harvesting adults for oil, skin, and feathers and as bait for crab and rock lobster fisheries; harvesting of eggs; terrestrial habitat degradation; marine pollution; fisheries bycatch and resource competition; environmental variability and climate change; and toxic algal poisoning and disease. Habitat loss, pollution, and fishing, all factors humans can readily mitigate, remain the primary threats for penguin species. Their future resilience to further climate change impacts will almost certainly depend on addressing current threats to existing habitat degradation on land and at sea. We suggest protection of breeding habitat, linked to the designation of appropriately scaled marine reserves, including in the High Seas, will be critical for the future conservation of penguins. However, large-scale conservation zones are not always practical or politically feasible and other ecosystem-based management methods that include spatial zoning, bycatch mitigation, and robust harvest control must be developed to maintain marine biodiversity and ensure that ecosystem functioning is maintained across a variety of scales.