Child-focused infant and early childhood mental health consultation: Shifting adult attributions to reduce the risk for preschool expulsion.

Infant and early childhood mental health consultation (IECMHC) in early care and education (ECE) settings is a promising approach to support young children. Although research on the effects of IECMHC is encouraging, it is limited by the complexities of the systems in which IECMHC is implemented and the variability in IECMHC models. The current study aims to clearly articulate a statewide, child-focused, short-term IECMHC model, assess consultee satisfaction, examine the effects of consultation on children's functioning in the school and home settings, and evaluate changes in teacher perceptions associated with expulsion risk following consultation. In total, 268 children ages 1-5 (69% White, 75% male) and their family and school caregivers participated in consultation in a New England state, and 95 children and caregivers were included in an evaluation subsample. Of this subsample, teachers and ECE administrators, but not families, indicated significant improvement in children's functioning from referral to end of consultation. There was also a significant decrease in children's risk of expulsion, as measured by teachers' perceptions associated with expulsion decisions. This study contributes to the IECMHC literature by providing results specific to a child-focused model of consultation and highlighting the possible role of adult attributions for children in ECE.

La consulta de salud mental infantil y la temprana niñez (IECMHC) en los entornos de cuidados y educación tempranos (ECE) es un acercamiento prometedor para apoyar a los niños pequeños. A pesar de que la investigación sobre los efectos de IECMHC es alentadora, está limitada por las complejidades de los sistemas dentro de los cuales se implementa IECMHC y la variabilidad en los modelos de IECMHC. El presente estudio se propone articular claramente un modelo de IECMHC para todo el estado, con enfoque en el niño y a corto plazo, evaluar la satisfacción que quienes participan de la consulta, examinar los efectos de la consulta sobre el funcionamiento de los niños en la escuela y en el entorno del hogar, así como evaluar los cambios en las percepciones de los maestros asociadas con los riesgos de expulsión después de la consulta. En total, 268 niños de edad 1­5 (69% blancos, 75% varones) y sus familias y quienes les cuidaba en la escuela participaron en la consulta en un estado de Nueva Inglaterra, y se incluyó a 95 niños y sus cuidadores en una evaluación de un subgrupo muestra. De este subgrupo muestra, los maestros y los administradores de ECE, pero no las familias, indicaron significativas mejorías en el funcionamiento de los niños desde la referencia hasta el final de la consulta. Se dio también una significativa disminución en el riesgo de expulsión de los niños, tal como se midió por medio de las percepciones de los maestros asociadas con las decisiones de expulsión. Este estudio contribuye a la literatura informativa sobre IECMHC por medio de ofrecer resultados específicos al modelo de consulta enfocado en el niño y subrayar el posible papel de las atribuciones del adulto para los niños en ECE.

La consultation de santé mentale du nourrisson et de la petite enfance (Infant and early childhood mental health consultation abrégé en anglais IECMHC) dans des contextes éducatifs et de crèches (abrégé ici CEC selon le français) est une approche prometteuse pour le soutien aux jeunes enfants. Bien que les recherches sur les effets de l'IECMHC sont encourageantes, elles sont limitées par les complexités des systèmes dans lesquels l'IECMHC est mise en oeuvre et la variabilité des modèles de l'IECMHC. Cette étude s'est donné pour but de clairement articuler un modèle IECMHC au niveau de l'état, focalisé sur l'enfant et à court terme, d'évaluer la satisfaction de la personne consultée, d'examiner les effets de la consultation sur le fonctionnement des enfants à l'école et à la maison, et d'évaluer les changements dans les perceptions de l'enseignant liée au risque d'expulsion après la consultation. En tout 268 enfants âgés de 1­5 ans (69% blancs, 75% garçons) et leur famille et les personnes prenant soin d'eux à l'école ont participé à une consultation dans un état de nous Nouvelle Angleterre (aux Etats­Unis), et 95 enfants et personnes prenant soin d'eux ont été inclus dans un sous­échantillon d'évaluation. Dans ce sous­échantillon les enseignants et administrateurs CEC, mais pas les familles, ont fait état d'une amélioration important dans le fonctionnement des enfants du moment de la référence à la fin de la consultation. Il n'a pas de baisse importante du risque d'expulsion des enfants, mesurée par les perceptions des enseignants liées aux décisions d'expulsion. Cette étude contribue aux recherches sur l'IECMHC en offrant des résultats spécifiques à un modèle de consultation focalisé sur l'enfant et en mettant en lumière le rôle possible des attributions adultes pour les enfants dans les CEC.

[Self-care education during Cardiac Rehabilitation programs for patients with Heart Failure with preserved Ejection Fraction: a Delphi Study]. / Educación en autocuidado durante programas de rehabilitación cardiaca para pacientes con insuficiencia cardiaca con fracción de eyección preservada: estudio Delphi.

OBJECTIVES: To develop a decalogue of self-care competencies to manage educational intervention during Cardiac Rehabilitation (CR) programs in Heart Failure with preserved Ejection Fraction (HFpEF) patients through multidisciplinary consensus. DESIGN: 3-round e-Delphi study using an initial questionnaire of 23 competencies based on the main recommendations of the CR and self-care guidelines. SITE: It was framed under the ethics of a randomised clinical trial developed at the Regional Hospital of Malaga. The survey was designed and disseminated as an online questionnaire. PARTICIPANTS: The expert panel comprised two patients with HFpEF and 13 healthcare professionals from Internal Medicine (n=3), Cardiology (n=2), Physiotherapy (n=3), Nursing (n=3) and Occupational Therapy (n=2). METHOD: The analysis of results included the content validity index, the percentage of agreement, and the concordance using Fleiss Kappa and Krippendorff's alpha. RESULTS: After the third round, 20 self-care competencies were identified, grouped into 12 domains, with sufficient consensus for their inclusion in the decalogue. CONCLUSIONS: The decalogue of self-care competencies generated from the multidisciplinary consensus guides education in patients with HFpEF, systematically addressing educational content tailored to patients for clinical practice in CR programs.

[Educational interventions in childhood asthma: A systematic review]. / Intervenciones educativas en asma infantil: Una revisión sistemática.

OBJECTIVE: To analyze educational interventions in pediatric asthmatic patients to achieve an adequate inhalation technique and improve their self-management. DESIGN: Systematic review based on the PRISMA recommendations. DATA SOURCES: Pubmed, Scopus, Cuiden, Web of Science and Google Scholar databases were reviewed. STUDY SELECTION: Sixteen articles published between 2014 and 2021 were included, with access to full text, languages: English, French and Spanish and pediatric population: 0-18 years. DATA EXTRACTION: Two thousand three hundred and thirteen children were participated. The variables analyzed were: level of care, type of intervention, correct performance of the inhalation technique, follow-up of the technique, delivery of written recommendations, professional-educator category, variables related to respiratory pathology, school absenteeism, quality of life and economic costs. RESULTS: The health care level was primary, hospital and community care, where specialist doctors, nurses and pharmacists stood out as educators. The most prevalent educational interventions are on-site demonstration and delivery of recommendations or multimedia interventions. Several articles report that asthma education is not carried out correctly, others state that their technique improves after the intervention, but most of them highlight the importance of periodic review of the technique. CONCLUSIONS: The authors report improvement in the inhalation technique in all of them, as well as greater self-management of the disease and adherence to treatment. It is necessary to intensify the education of patients in the correct handling of the devices, and the follow-up and subsequent review to optimize the control of the disease.

[Exploring Needs, Motivations, and Limitations Towards Healthy Eating and Digital Resources: A Qualitative Study in a Mexican Primary Education Setting]. / Exploración de necesidades, motivaciones y limitaciones en relación con la alimentación saludable y recursos digitales: un estudio cualitativo en un entorno de educación primaria en México.

OBJECTIVE: To explore the needs, motivations, and limitations related to healthy eating and digital materials, as well as to identify patterns for their design as a strategy aimed at Mexican families. DESIGN: A qualitative observational study of the phenomenon through focus group sessions. LOCATION: A public primary education center in the city of Querétaro, Mexico. PARTICIPANTS: Children aged 9 to 11 years and parents, mothers, or caregivers with children in primary education. METHOD: Twelve sessions were conducted with three groups of students and two sessions with parents, mothers, or caregivers using an interview guide. Various digital materials, developed based on social cognitive theory, were presented during the sessions. The sessions were recorded with the participants' or their guardians' prior consent and transcribed for analysis. Coding was performed for key points of analysis, and information saturation was confirmed. RESULTS: Students expressed motivation towards digital material that promotes play and experimentation, especially within the family context. The main perceived barrier was the caregivers' resistance to change. Parents expressed motivation and a need for explanatory material on diseases, with economic and time-related barriers. CONCLUSIONS: Digital material based on social cognitive theory, designed to improve nutrition, can be an effective strategy in nutritional education if it considers the circumstances of the target population. It is advisable to include affective and behavioral elements to achieve meaningful learning within households.

[Family and community medicine: The most chosen specialty in the MIR]. / Medicina familiar y comunitaria: la especialidad más elegida en el MIR.

Family and Community Medicine is the most offered and chosen specialty in the MIR (Spanish medical residency examination), however, every year its attractiveness is questioned due to not all offered positions being filled and a certain number of resident doctors deciding not to continue in this specialty once started. In this context, some of the proposals to address the problem focus on increasing the supply when the facts show that the challenge lies in addressing the demand by making the specialty and its professional scope more attractive. The problem and its determinants are analyzed in this context by focusing on four elements that may be influencing it: the vocational aspects of medical graduates who pursue specialization, the characteristics of the specialty program and the teaching units where training is carried out, the presence of family medicine in the university as a key element for knowledge and affinity to this specialty from undergraduate studies, and finally, the situation of primary care as the space where training is materialized and the priority setting for the professional practice of future specialists.

Learning outcomes measured in zoo and aquarium conservation education.

Communicating the topic of conservation to the public and encouraging proenvironmental behaviors can mitigate loss of biodiversity. Thus, the evaluation of educational efforts is important to ascertain the educational effects and provide high-quality conservation education. The learning outcomes of conservation education are diverse (e.g., attitudes, knowledge, and behavior). Considering the specific characteristics of these different outcomes and the factors that influence them is crucial to delivering successful conservation education. We reviewed 29 peer-reviewed articles published in English from January 2011 to April 2020 on empirical studies of learning outcomes of on-site conservation education in zoos and aquaria, institutions that seek to educate the public about conservation. We examined the range of learning outcomes, their definitions, and factors that influenced them. Cognitive outcomes were most frequently investigated (37%) in comparison with other outcomes (e.g., affective outcomes, 31%). The articles did not use explicit definitions for learning outcomes, and implicit or explorative definitions provided were inconsistent. Outcomes were influenced by various factors (e.g., prior experiences, staff interaction, animal behavior). Our results suggest the agenda of conservation education research should be broadened by examining all learning outcomes relevant to behavior change. Educational and behavior change theories should be used as a background for conservation education research to ensure clear and consistent definitions, derive appropriate instruments to measure learning outcomes, and relate learning outcomes to influencing factors. We recommend conservation education researchers and practitioners to treat conservation education holistically and acknowledge its learning outcomes' full complexity.

Resultados del Aprendizaje Medidos en la Educación para la Conservación en Zoológicos y Acuarios Resumen La comunicación del tema de conservación y el fomento de las conductas proambientales entre el público puede mitigar la pérdida de la biodiversidad. Así, la evaluación de los esfuerzos educativos es importante para determinar sus efectos y proporcionar una educación para la conservación de gran calidad. Los resultados del aprendizaje de la educación para la conservación son diversos (p.ej.: actitudes, conocimiento y comportamiento). Es importante considerar las características específicas de estos diferentes resultados y los factores que les influyen para proporcionar una educación para la conservación exitosa. Analizamos 29 artículos, revisados por pares y publicados en inglés entre enero de 2011 y abril de 2020, sobre los estudios empíricos de los resultados del aprendizaje de la educación para la conservación in situ en zoológicos y acuarios, instituciones que educan al público sobre la conservación. Analizamos la variedad de resultados del aprendizaje, sus definiciones y los factores que les influyen. Los resultados cognitivos fueron los que se investigaron con mayor frecuencia (37%) en comparación con otros resultados (p.ej.: resultados afectivos, 31%). Los artículos no usaron definiciones explícitas para los resultados del aprendizaje, y las definiciones implícitas o exploratorias que se proporcionaron fueron incoherentes. Los resultados estuvieron influenciados por diversos factores (p.ej.: experiencias previas, interacción con el personal, comportamiento animal). Nuestros resultados sugieren que la agenda de la investigación sobre la educación para la conservación debería extenderse mediante la examinación de los resultados del aprendizaje relevantes para el cambio en el comportamiento. Las teorías del cambio educativo y conductual deberían usarse como trasfondo para la investigación sobre la educación para la conservación para garantizar definiciones claras y concisas, derivar instrumentos adecuados para medir los resultados del aprendizaje y relacionar los resultados del aprendizaje con los factores influyentes. Recomendamos que los investigadores y los practicantes de la educación para la conservación la manejen de forma holística y reconozcan toda la complejidad de sus resultados de aprendizaje.

Updating the evidence: A systematic review of a decade of Infant and Early Childhood Mental Health Consultation (IECMHC) research.

Infant and Early Childhood Mental Health Consultation (IECMHC) is a preventative, capacity-building intervention in which mental health professionals partner with early childhood professionals to indirectly improve the environments and relationships that young children experience. Prior research has demonstrated that IECMHC is associated with positive outcomes for children, teachers, and classrooms. Over the past decade, IECMHC implementation and research have expanded, warranting an updated review. The current paper provides an update of the IECMHC evidence base. Included studies (n = 16) were systematically gathered, screened, and coded for context, intervention characteristics, methods and measures, outcomes across ecological levels, and alignment with the IDEAS Impact Framework's guiding questions. Our analysis replicates prior reviews, describing the positive impact of IECMHC on outcomes such as child externalizing behavior, teacher self-efficacy, and teacher-child interactions. Beyond updating prior reviews, this analysis describes emerging, nuanced findings regarding the mechanisms of change and the differential impact of IECMHC. We augment our review with descriptions of evaluations that did not meet our inclusion criteria (e.g., IECMHC in the home visiting context, unpublished evaluation reports) to provide context for our findings. Finally, we provide policy and practice implications and articulate an agenda for future research.

[Education interventions in heart failure using m-Health: Systematic review]. / Educación terapéutica en insuficiencia cardiaca mediante e-Salud: revisión sistemática.

OBJECTIVE: To provide the best scientific evidence available on the effectiveness of therapeutic education programs through digital health in patients with heart failure. DESIGN: Systematic review of randomized clinical trials. DATA SOURCES: Six databases were included due to their relevance in Health Sciences: PubMed, EMBASE, Scielo, Cochrane, CINAHL, and Web of Science. SELECTION OF STUDIES: In English and Spanish, studies carried out between 2018 and 2023 were selected. After evaluating the methodological quality of the studies, the Jadad tool was used to discriminate those that did not meet said quality. In total, 8 articles from 6 different countries were included. DATA EXTRACTION: The review and analysis of the documents were carried out by independent pairs. The Cochrane tool for RoB 2 randomized clinical trials was used to assess the risk of bias. RESULTS: All the applications had therapeutic education, it was also assessed that they had monitoring, evaluation of signs and symptoms, drug titration, and professional follow-up through the application. CONCLUSION: This review reveals the significant impact of therapeutic education in increasing patient knowledge, reducing hospital readmissions, and improving functional status and self-care. This makes digital health a valuable tool to complement nursing care in patients with heart failure.

Inadequate diabetes knowledge is associated with poor glycemia control in patients with type 2 diabetes.

OBJECTIVE: To identify the association between glycemia control with level of diabetes knowledge, diabetes education, and lifestyle variables in patients with type 2 diabetes. DESIGN: Cross-sectional analytical study. SITE: Clinics of the Mexican Institute of Social Security (IMSS), Mexico. PARTICIPANTS: Patients with type 2 diabetes. MAIN MEASUREMENTS: Glycated hemoglobin (HbA1c), glucose, and lipid profile levels were measured from fasting venous blood samples. Assessment of disease knowledge was performed using the Diabetes Knowledge Questionnaire (DKQ-24). Systolic and diastolic blood pressure was measured. Weight and abdominal circumference were measured, as well as body composition using bioimpedance. Sociodemographic, clinical, and lifestyle variables were obtained. RESULTS: A total of 297 patients were included, sixty-seven percent (67%) were women with a median of six years since the diagnosis of diabetes. Only 7% of patients had adequate diabetes knowledge, and 56% had regular knowledge. Patients with adequate diabetes knowledge had a lower body mass index (p=0.016), lower percentage of fat (p=0.008), and lower fat mass (p=0.018); followed a diet (p=0.004) and had received diabetes education (p=0.002), and to obtain information about their illness (p=0.001). Patients with low levels of diabetes knowledge had a higher risk of HbA1c≥7% (OR: 4.68; 95% CI: 1.48,14.86; p=0.009), as well as those who did not receive diabetes education (OR: 2.17; 95% CI: 1.21-3.90; p=0.009) and those who did not follow a diet (OR: 2.37; 95% CI: 1.01,5.55; p=0.046). CONCLUSION: Inadequate knowledge of diabetes, lack of diabetes education, and dietary adherence are associated with poor glycemia control in patients with diabetes.

[ADHEFAP: Clinical trial to evaluate an educational-behavioral telephone intervention by the primary care pharmacist to improve therapeutic adherence]. / ADHEFAP: ensayo clínico para evaluar una intervención telefónica educacional-conductual por el farmacéutico de atención primaria en la mejora de la adherencia terapéutica.

OBJECTIVE: Evaluate the improvement in therapeutic adherence of an intervention based on telephone monitoring by the primary care pharmacist. DESIGN: Randomized open controlled trial. LOCATION: This study was carried out in 2021 by a multidisciplinary team working with health professionals of thirteen health centers belonging to four health districts in Community of Madrid, Spain. PARTICIPANTS: These were patients (60-74 years) with polipharmacy classified as non-adherent according to the Morisky-Green test. Two hundred and twenty-four patients were originally enrolled, 87 of them were non-adherents. Of these, 15 were lost and 72 were finally randomized. Seventy-one patients completed the study (33 intervention group and 38 control group). INTERVENTIONS: Patients randomized to the intervention arm were included in a follow-up telephone program consisting of an interview at months 1, 2, and 3 to improve adherence. The Morisky-Green test was repeated at month 4 to assess improvement. In the control group this test was only performed at month 4. MAIN MEASUREMENTS: Adherence measured by Morisky-Green at baseline and at 4th month. RESULTS: The 72.7% of patients in the intervention group became adherent while only 34.2% did in the control arm, being the difference 38.5% (95% CI: 17.1-59.9), statistically significant (P=.001). CONCLUSIONS: After a follow-up educational-behavioral telephone intervention in non-adherent patients by the primary care pharmacist, therapeutic adherence was improved statistically significantly in the intervention group compared with the control group.

[The new program of the Family and Community Medicine specialty: An opportunity not to be missed]. / El nuevo programa de la especialidad de medicina familiar y comunitaria: una oportunidad que no se debe perder.

The training program for the Family and Community Medicine specialty (MFyC), which has been in effect since 2005, is currently undergoing a review and update process. This article proposes contributions to deepen the specific contents of the specialty in order to guide towards a more significant competency development. To carry out values-oriented training, it is suggested to deploy the values function and promote the creation of care spaces where the daily experience of those values is possible. It is proposed to establish a scale of values where the two essential values of the family physician are, in this order, a commitment to the individual person, and a commitment to the group of people under their care. Additionally, it is proposed to reorganize the competency map around five competency integrators or meta-competencies: patient-centered clinical method, population-based clinical governance, primary care oriented to the community, health promotion or community health based on assets, and research in the family and community field.

Medicine and the metaverse: current applications and future.

Innovative technologies such as the metaverse and chat GPT-4 (based on artificial intelligence) are present in the daily discourse of society; recently, they have been introduced into medical practice and are bringing about important changes. In the case of the metaverse ("beyond the universe"), various medical schools and departments around the world are beginning to use it as an innovative strategy for teaching subjects such as anatomy, histology, ophthalmology, and simulation in parallel (virtual) worlds for learning and supervision of surgeries, as well as for other applications in medical education and in the doctor-patient relationship. Although it should be regarded as an area of opportunity for the transformation of medicine, it is important to consider the various limitations and risks of the metaverse in medical practice, student training, and physicians' relationship with the health problems they have to deal with in their practice.

Las innovadoras tecnologías del metaverso y el chat GPT4 (basado en inteligencia artificial) están presentes en el discurso cotidiano de la sociedad; recientemente se han introducido en la práctica médica y están provocando importantes cambios. En cuanto al metaverso ("después del universo"), diversas escuelas y facultades de medicina del mundo comienzan a utilizarlo como una estrategia innovadora dirigida a la enseñanza de materias como anatomía, histología, oftalmología y simulación en mundos paralelos (virtuales) para el aprendizaje y supervisión de cirugías, así como para otras aplicaciones en educación médica y en la relación médico-paciente. Si bien debe tomarse en cuenta como un área de oportunidad para la transformación de la medicina, es importante considerar las diversas limitaciones y riesgos del metaverso en la práctica médica, la formación de estudiantes y la relación del médico con los problemas de salud a los que se enfrenta en su práctica.

Health sciences undergraduate students academic track records.

BACKGROUND: Academic track record analysis is essential for evaluating the training of students and the structure of higher education study programs, which allows diagnosing and preventing educational lag and school dropout. OBJECTIVE: To analyze the differences in academic track records of UNAM health sciences undergraduate students from generations 2001 to 2016. MATERIAL AND METHODS: Study of real cohorts; graduation and lag rates were calculated. ANOVA was used to contrast the graduation rates between campuses by undergraduate program and time. To identify critical periods, survival functions were used with Kaplan-Meier's method. RESULTS: The lowest percentages of lag were observed in nursing and medicine students; nursing students had the highest graduation rates, especially at Zaragoza campus; dentistry students had the lowest graduation rates and the highest dropout and lag rates. Women showed higher graduation rates and lower risk of dropout and lag. CONCLUSIONS: Nursing, medicine and psychology undergraduate students at Zaragoza and Iztacala campuses, with modular programs, achieved the highest graduation percentages and the lowest dropout and lag rates.

ANTECEDENTES: El análisis de las trayectorias académicas es fundamental para evaluar la formación de los estudiantes y la estructura de los programas de estudio de educación superior, lo que permite diagnosticar y prevenir el rezago y abandono escolar. OBJETIVO: Analizar las diferencias en las trayectorias académicas de los estudiantes de las licenciaturas en ciencias de la salud de la UNAM de las generaciones 2001 a 2016. MATERIAL Y MÉTODOS: Estudio de cohortes reales; se calcularon tasas de egreso y rezago. Se realizó ANOVA para contrastar el egreso entre planteles por carrera y tiempo. Para identificar los períodos críticos se utilizaron funciones de supervivencia con el método de Kaplan-Meier. RESULTADOS: En las licenciaturas en enfermería y medicina se observaron los menores porcentajes de rezago; enfermería presentó los mayores porcentajes de egreso, sobre todo en la Facultad de Estudios Superiores Zaragoza; odontología mostró los menores índices de egreso y mayores índices de abandono y rezago. Las mujeres mostraron mayor egreso y menor riesgo de abandono y rezago. CONCLUSIONES: Los estudiantes de las licenciaturas en enfermería, medicina y psicología de las facultades de estudios superiores Zaragoza e Iztacala, con programas modulares, alcanzaron los mayores porcentajes de egreso y menores índices de abandono y rezago.

ChatGPT: opportunities and risks in the fields of medical care, teaching, and research.

ChatGPT is a virtual assistant with artificial intelligence (AI) that uses natural language to communicate, i.e., it holds conversations as those that would take place with another human being. It can be applied at all educational levels, including medical education, where it can impact medical training, research, the writing of scientific articles, clinical care, and personalized medicine. It can modify interactions between physicians and patients and thus improve the standards of healthcare quality and safety, for example, by suggesting preventive measures in a patient that sometimes are not considered by the physician for multiple reasons. ChatGPT potential uses in medical education, as a tool to support the writing of scientific articles, as a medical care assistant for patients and doctors for a more personalized medical approach, are some of the applications discussed in this article. Ethical aspects, originality, inappropriate or incorrect content, incorrect citations, cybersecurity, hallucinations, and plagiarism are some examples of situations to be considered when using AI-based tools in medicine.

ChatGPT es un asistente virtual con inteligencia artificial que utiliza lenguaje natural para comunicarse, es decir, mantiene conversaciones como las que se tendrían con otro humano. Puede aplicarse en educación a todos los niveles, que incluye la educación médica, en donde puede impactar en la formación, la investigación, la escritura de artículos científicos, la atención clínica y la medicina personalizada. Puede modificar la interacción entre médicos y pacientes para mejorar los estándares de calidad de la atención médica y la seguridad, por ejemplo, al sugerir medidas preventivas en un paciente que en ocasiones no son consideradas por el médico por múltiples causas. Los usos potenciales del ChatGPT en la educación médica, como una herramienta de ayuda en la redacción de artículos científicos, un asistente en la atención para pacientes y médicos para una práctica más personalizada, son algunas de las aplicaciones que se analizan en este artículo. Los aspectos éticos, originalidad, contenido inapropiado o incorrecto, citas incorrectas, ciberseguridad, alucinaciones y plagio son ejemplos de las situaciones a tomar en cuenta al usar las herramientas basadas en inteligencia artificial en medicina.

Analysis of Undergraduate Dermatology Syllabi at Spanish Universities: Does the Weight of Theoretical Content Match the Skin Conditions Seen in Primary Care and General Dermatology Practices? / Análisis de las características de la docencia de pregrado de Dermatología en las universidades españolas. ¿Los contenidos teóricos se aproximan a la casuística de los médicos de Atención Primaria y dermatólogos generales?

INTRODUCTION: Undergraduate dermatology courses vary in the nearly 50 Spanish medical faculties that teach the subject. This study aimed to describe the characteristics of these courses and to analyze whether the weight assigned to dermatology topics reflect the caseloads of primary care physicians and general dermatologists in the Spanish national health system. MATERIAL AND METHODS: Cross-sectional study of syllabi used in Spanish medical faculties during the 2021-2022 academic year. We determined the number of teaching hours in public and private university curricula and compared the weight of dermatology topics covered to the dermatology caseloads of primary care physicians and general dermatologists as reported in published studies. RESULTS: Most medical faculties taught dermatology for one semester. The median number of credits offered was 4.5. On average, lectures covered 24 theoretical topics, and seminars and workshops covered 9 topics. We identified a clear disparity between the percentage of time devoted to dermatology topics in course lectures and the skin conditions usually managed in primary care and general dermatology practices. DISCUSSION: The skin diseases most commonly treated by primary care physicians and general dermatologists are underrepresented in the curricula of Spanish medical faculties. The topics that should be given more weight in syllabi, or recovered for inclusion in dermatology courses, should be re-examined. Our findings show that the topics that ideally should be emphasized more are types of dermatitis, infectious skin diseases, acne, psoriasis, rashes, and the differential diagnosis of benign and malignant neoplasms. There should be additional support for the theoretical teaching of these topics.

Pain and Late-Onset of Hidradenitis Suppurativa Can Have a Negative Influence on Occupational Status and Educational Level. A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa is a chronic and painful condition with negative impact on daily activity. Little information on the impact of disease-specific factors on educational level and occupational status in hidradenitis suppurativa patients has been reported. We sought to identify how disease-specific factors could influence occupational status and educational level in patients with hidradenitis suppurativa. METHODS: Cross-sectional study of patients with hidradenitis suppurativa seen between September 2017 and September 2018. Disease-specific variables were analyzed to find associations in patients with different educational levels and occupational status. RESULTS: Ninety-eight patients were included. Patients with non-university studies had more frequently≥3 affected areas (22.5% [16/73] vs 4.8% [1/22], p=0.049), a higher number of painful days (8.5 [SD 8.8] vs 4.6 [SD 4.8], p=0.048) and a higher score on the VAS scale (6.7 [SD 2.8] vs 5.0 [3.3], p=0.031). Patients from the inactive group had a significantly increased number of painful days (11.2 [SD 10.4] vs 5.7 [SD 6.2], p=0.004). This group had a greater number of patients with a history of depression (61.3% [19/31] vs 27.4% [17/62], p=0.002) and a higher mean BMI (32.3 [9.1] vs 28.4 [6.4], p=0.016). Late disease onset was significantly associated with being "inactive" (26.7% [8/31] vs 6.5% [4/62], p=0.026). No significant differences between severity scales of hidradenitis suppurativa and educational level or occupational status were found. LIMITATIONS: cross-sectional and single center study. CONCLUSIONS: Pain, ≥3 affected areas, history of depression, higher mean BMI, and late onset of hidradenitis suppurativa, are associated with low education level and inactive occupational status.

Pain and late-onset of hidradenitis suppurativa can have a negative influence on occupational status and educational level. A cross-sectional study. / [Artículo traducido] El dolor y la aparición tardía de la hidrosadenitis supurativa pueden tener una influencia negativa en el estatus ocupacional y el nivel educativo. Estudio transversal.

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa (HS) is a chronic and painful condition with negative impact on daily activity. Little information on the impact of disease-specific factors on educational level and occupational status in hidradenitis suppurativa patients has been reported. We sought to identify how disease-specific factors could influence occupational status and educational level in patients with HS. METHODS: Cross-sectional study of patients with HS seen between September 2017 and September 2018. Disease-specific variables were analyzed to find associations in patients with different educational levels and occupational status. RESULTS: Ninety-eight patients were included. Patients with non-university studies had more frequently ≥ 3 affected areas (22.5% [16/73] vs. 4.8% [1/22], p = 0.049), a higher number of painful days (8.5 [SD 8.8] vs. 4.6 [SD 4.8], p = 0.048) and a higher score on the VAS scale (6.7 [SD 2.8] vs. 5.0 [3.3], p = 0.031). Patients from the inactive group had a significantly increased number of painful days (11.2 [SD 10.4] vs. 5.7 [SD 6.2], p = 0.004). This group had a greater number of patients with a history of depression (61.3% [19/31] vs. 27.4% [17/62], p = 0.002) and a higher mean BMI (32.3 [9.1] vs. 28.4 [6.4], p = 0.016). Late disease onset was significantly associated with being «inactive¼ (26.7% [8/31] vs. 6.5% [4/62], p = 0.026). No significant differences between severity scales of HS and educational level or occupational status were found. LIMITATIONS: cross-sectional and single center study. CONCLUSIONS: Pain, ≥ 3 affected areas, history of depression, higher mean BMI, and late onset of HS, are associated with low education level and inactive occupational status.

Typifying conservation practitioners' views on the role of education.

Education is an established tool to enhance human-environment relationships, despite the lack of empirical evidence to support its use. We used theories of change to unpack assumptions about the role of education in conservation. We interviewed practitioners from 15 conservation organizations in Madagascar to typify implicit pathways of change and assess whether emerging pathways echo theoretical advances. Five pathways were drivers of change: increasing knowledge, changing emotional connection and changing traditional cultural practices, fostering leaders, diversifying outcomes, and influencing community and society. These pathways reflect existing sociopsychological theories on learning and behavioral change. Most interviewees' organizations had a predominant pathway that was often combined with elements from other pathways. Most pathways lacked culturally grounded approaches. Our research reveals assumptions about the role of education in conservation and indicates that organizations had different ideas of how change happens. The diversity of practices reflects the complexity of factors that influence behavior. Whether this diversity is driven by local sociocultural context, interaction with other conservation approaches, or contingencies remains unclear. Yet, typifying the pathways of change and reflecting on them is the first step towards comprehensive evaluation of when and which pathways and interactions to promote.

Caracterización de la Visión de los Profesionales de la Conservación sobre el Papel de la Educación Resumen La educación es una herramienta consolidada para mejorar las relaciones entre la humanidad y el medio ambiente, a pesar de la falta de evidencia empírica que respalde su uso. Usamos teorías del cambio para desentrañar las suposiciones sobre el papel de la educación en la conservación. Entrevistamos a profesionales de 15 organizaciones de conservación en Madagascar para caracterizar las vías implícitas de cambio y para analizar si las vías emergentes reflejan los avances teóricos. Cinco vías fueron impulsoras del cambio: el incremento del conocimiento, el cambio de la conexión emocional y el cambio de las prácticas culturales tradicionales, el fomento al liderazgo, la diversificación de resultados, y la influencia sobre la comunidad y la sociedad. Estas vías reflejan las teorías socio-psicológicas existentes sobre el aprendizaje y el cambio de comportamiento. La mayoría de las organizaciones de los entrevistados tuvo una vía predominante que con frecuencia estuvo combinada con los elementos de otras vías. La mayoría de las vías careció de estrategias fundamentadas culturalmente. Nuestra investigación reveló las suposiciones sobre el papel de la educación en la conservación e indica que las organizaciones tenían ideas diferentes sobre cómo ocurren los cambios. La diversidad de prácticas refleja la complejidad de los factores que influyen en el comportamiento. Todavía no está claro si esta diversidad es causada por el contexto sociocultural local, la interacción con otras estrategias de conservación o con las eventualidades. Aun así, caracterizar las vías de cambio y reflexionar sobre ellas es el primer paso hacia la evaluación integral de cuándo y cuáles vías e interacciones se deben promover.

Online relationship education for help-seeking low-income couples: A Bayesian replication and extension of the OurRelationship and ePREP programs.

Low-income couples are at increased risk for relationship instability and divorce. In response, online relationship education programs such as ePREP and OurRelationship have been developed to more easily reach this population. A previous trial indicated that these programs promote relationship functioning (Doss et al., 2020) and individual well-being (Roddy et al., 2020a). However, given that these effects were notably larger than previous studies of in-person relationship education and approached effect sizes observed in couple therapy, it is possible that the magnitude of these effects was somewhat spurious; therefore, these findings need replication. The current manuscript seeks to replicate these programs' previous effects on relationship functioning and determine whether these effects are stable. Using a sample of 671 low-income couples seeking relationship help (N = 1337 individuals) and Bayesian estimation, the current study replicated previous findings that the OurRelationship and ePREP programs offered with four coaching calls produced reliable improvements in relationship functioning relative to a 6-month waitlist control group. There were no statistically reliable differences between the two active interventions. Bayesian analyses indicated that the effects of the two online programs were larger than the average effects of in-person relationship education for low-income couples reported in previous studies, roughly equivalent to efficacy studies of in-person relationship education reported in previous studies, smaller than those that resulted from the OurRelationship program delivered to distressed couples without an income requirement and smaller than couple therapy.

Las parejas de bajos recursos tienen mayor riesgo de inestabilidad en las relaciones y de divorcio. En respuesta a esto, se han desarrollado programas de educación sobre las relaciones, como ePREP y OurRelationship, con el fin de llegar más fácilmente a esta población. Un ensayo previo indicó que estos programas promueven el funcionamiento de las relaciones (Doss et al., 2020) y el bienestar individual (Roddy et al., 2020a). Sin embargo, teniendo en cuenta que estos efectos fueron notablemente mayores que los de estudios previos de la educación presencial sobre las relaciones y que abordaron tamaños del efecto observados en la terapia de pareja, es posible que la magnitud de estos efectos fuera de alguna manera falsa, por lo tanto, estos resultados necesitan repetirse. En el presente manuscrito se busca reproducir los efectos previos de estos programas en el funcionamiento de la relación y determinar si estos efectos son estables. Utilizando una muestra de 671 parejas de bajos recursos que buscaban ayuda para las relaciones (N = 1337 personas) y el cálculo bayesiano, el presente estudio reprodujo los resultados anteriores que ofrecieron los programas OurRelationship y ePREP con cuatro llamados de capacitación, generando mejoras fiables en el funcionamiento de la relación respecto de un grupo de referencia en lista de espera de seis meses. No hubo diferencias estadísticamente fiables entre las dos intervenciones activas. Los análisis bayesianos indicaron que los efectos de los dos programas virtuales fueron mayores que los efectos promedio de la educación presencial sobre las relaciones para parejas de bajos recursos informados en estudios previos, aproximadamente equivalentes a los de los estudios de eficacia de la educación presencial sobre las relaciones informados en estudios previos, menores que los obtenidos del programa OurRelationship impartido a parejas con distrés sin requisitos de ingresos, y menores que los de la terapia de pareja.

Concurrent randomized control trials of the 1-year efficacy of two couple relationship education programs: ELEVATE and Couples Connecting Mindfully.

A long-standing university-community partnership used a longitudinal randomized control trial to implement and evaluate two couple relationship education (CRE) curricula, ELEVATE and Couples Connecting Mindfully (CCM), among an economically and racially diverse population of adult couples. Married and non-married couples (n = 929 couples) completed baseline surveys and were randomly assigned to either one of the two program groups or to the control group by implementation site. Follow-up surveys were collected at 2 months, 6 months, and 1 year after baseline. Using an intent-to-treat approach, growth curve modeling comparisons of trajectories indicated program effects at 1 year post-baseline in key outcome areas. Both the ELEVATE and the CCM group reported significant gains in couple relationship skills, couple quality, and family harmony over time compared to the control group that experienced either no change or declines. Further, the ELEVATE group also demonstrated positive program effects on measures of mental health and sleep quality. An assessment of the central premise of CRE indicated that the immediate post-program improvements in couple relationship skills predicted later couple quality for both program groups. This study indicates that both ELEVATE and CCM can be considered evidence-based CRE programs for use with a broad population of couples.

Una asociación duradera entre la universidad y la comunidad utilizó un ensayo controlado aleatorizado y longitudinal para implementar y evaluar dos currículos de educación sobre las relaciones de pareja, ELEVATE y Couples Connecting Mindfully (CCM), entre una población de parejas adultas económicamente y racialmente diversa. Parejas casadas y no casadas (n = 929 parejas) contestaron encuestas en el momento basal, y luego, en el lugar de implementación, se las distribuyó aleatoriamente a alguno de los dos grupos del programa o al grupo de referencia. Se recogieron encuestas de seguimiento dos meses, seis meses y un año después del momento basal. Utilizando un método por intención de tratar, las comparaciones de trayectorias del modelo de curva del crecimiento indicaron efectos del programa un año después del momento basal en áreas de resultado claves. Tanto el grupo de ELEVATE como el de CCM informaron beneficios significativos en las habilidades para las relaciones de pareja, la calidad de la pareja y la armonía familiar con el tiempo en comparación con el grupo de referencia, que no tuvo ningún cambio ni empeoramientos. Además, el grupo de ELEVATE también demostró efectos del programa en las medidas de salud mental y calidad del sueño. Una evaluación de la premisa fundamental de la educación sobre las relaciones de pareja indicó que las mejoras inmediatas después del programa en las habilidades para las relaciones de pareja predijeron una posterior calidad de la pareja para ambos grupos del programa. Este estudio indica que tanto ELEVATE como CCM pueden considerarse programas factuales de educación sobre las relaciones de pareja aptos para su uso con una amplia población de parejas.