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This paper presents a comprehensive review of the literature on electronic reading (e-reading) versus paper reading. The main objective was to assess the current state of research comparing digital and paper reading outcomes among students aged 6–18 years old, as well as assessing the impact of various factors (gender, socioeconomic status, and school location) in explaining the differences between the two modes. Inclusion criteria included the following: participants (6–18 years), research focus (comparing digital reading and paper reading), study type (quantitative or mixed methods), publication (peer reviewed between 2015 and 2022), and language (English). A systematic search in four databases (WOS, Scopus, ERIC, and JSTOR) in August 2022 was conducted by three reviewers. The search revealed 23 studies matching the inclusion criteria. The findings from the reviewed studies are diverse, with some reporting no significant differences in reading comprehension between the two modes, while others suggest screen inferiority, thereby favoring paper reading. Individual-level predictors, such as prior comprehension skills and reading habits, play a crucial role in determining reading performance across modes. Family-level factors, such as the number of books at home, and school-level factors, like the usage of ICT resources, influence both paper and digital reading comprehension. Moreover, gender differences in attitudes and performance towards different reading modes are apparent. SES is positively associated with reading achievement in both modes, with a larger effect shown for paper reading. Overall, the comparison between electronic and paper reading modes reveals a complex interplay of individual and contextual factors influencing reading comprehension and attitudes.

INTRODUCTION. The twentieth century saw a strong process of medicalization and thetechnification of care. In recent years, we are experiencing a change in the health care model and the concept of humanized childbirth is emerging. A tool to encourage this and avoid obstetric violence is the birth plan. The midwife hasa fundamental role in it.OBJECTIVES. Describe the concept of humanized childbirth care, know the role of the midwife in it and delve into the vindication of women, while identifying the historical evolution on this subject. METHODOLOGY. Bibliographic review through the PubMed, CINAHL, Scopus, and CercaBib databases. 15 articles were selected and a bibliometric analysis has been carried out using the tool VosViewer. RESULTS. Humanized care is focused on empowering and dignifying women, so they have an active and decisive role and can live the birth process as a positive experience. The birth plan is an instrument that positively influences this process and maternal-fetal outcomes, so its use is encouraged. In addition, midwives are essential in the implementation of humanized care that allows to avoid situations of obstetric violence. CONCLUSION. It is important that health professionals adopt ethical sensitivity that contributes to this respect for women’s autonomy and avoid situations of obstetric violence. It is necessary to change the obstetric model in the training of health professionals so that they become aware and adopt training models that tend to improve the quality of care.

Objective: The need to generate evidence related to COVID-19, the acceleration of publication and peer-review process and the competition between journals may have influenced the quality of COVID-19 papers. Our objective was to compare the characteristics of COVID-19 papers against those of non-COVID-19 papers and identify the variables in which they differ. Method: We conducted a journal-matched case-control study. Cases were COVID-19 papers and controls were non-COVID-19 papers published between March 2020 and January 2021. Journals belonging to five different Journal Citations Reports categories were selected. Within each selected journal, a COVID-19 paper (where there was one) and another non-COVID-19 paper were selected. Conditional logistic regression models were fitted. Results: We included 81 COVID-19 and 143 non-COVID-19 papers. Descriptive observational studies and analytical observational studies had, respectively, a 55-fold (odds ratio [OR]: 55.12; 95% confidence interval [95%CI]: 7.41-409.84) and 19-fold (OR: 19.28; 95%CI: 3.09-120.31) higher likelihood of being COVID-19 papers, respectively, and also a higher probability of having a smaller sample size (OR: 7.15; 95%CI: 2.33-21.94). COVID-19 papers had a higher probability of being cited since their publication (OR: 4.97; 95%CI: 1.63-15.10). Conclusions: The characteristics of COVID-19 papers differed from those of non-COVID-19 papers published in the first months of the pandemic. In order to ensure the publication of good scientific evidence the quality of COVID-19-papers should be preserved. Resumen: Objetivo: La necesidad de generar evidencia relacionada con la COVID-19, la aceleración del proceso de revisión por pares y publicación, y la competencia entre revistas, pueden haber influido en la calidad de los artículos sobre la COVID-19. El objetivo fue comparar las características de los artículos sobre la COVID-19 con las de los artículos no COVID-19 e identificar las variables en las que difieren. Método: Se realizó un estudio de casos y controles emparejados por revista. Los casos eran artículos COVID-19 y los controles eran artículos no COVID-19 publicados en el mismo periodo. Se seleccionaron revistas pertenecientes a cinco categorías diferentes del Journal Citations Reports. Dentro de cada revista seleccionada, se escogió un artículo COVID-19 (cuando había uno) y otro artículo no COVID-19. Se ajustaron modelos de regresión logística condicional. Resultados: Se incluyeron 81 artículos COVID-19 y 143 artículos no COVID-19. Los estudios observacionales descriptivos y los estudios observacionales analíticos tenían, respectivamente, una probabilidad 55 veces mayor (odds ratio [OR]: 55,12; intervalo de confianza del 95% [IC95%]: 7,41-409,84) y 19 veces mayor (OR: 19,28; IC95%: 3,09-120,31) de ser artículos COVID-19 y de tener un tamaño de muestra menor (OR: 7,15; IC95%: 2,33-21,94). Los artículos más citados desde su publicación tenían 5 veces más probabilidades de ser artículos COVID-19 (OR: 4,97; IC95%: 1,63-15,10). Conclusiones: Los artículos COVID-19 parecen tener mayor impacto bibliométrico, a pesar de tener menor calidad metodológica. Para asegurar la publicación de buena evidencia científica se debe preservar la calidad de los artículos relacionados con la COVID-19.

Introduction: the student scientific activity is a dynamic process that includes all the activities that are carried out during a course, among which are: the Student Scientific Day, so it is of interest its analysis in order to find barriers and strengths. Objective: to characterize some metrics of the works presented in the XXXII Student Scientific Conference of the University of Medical Sciences of Las Tunas. Methods: a descriptive and transversal bibliometric study was carried out in January 2022 with the papers presented at the XXXII Student Scientific Conference of the University of Medical Sciences of Las Tunas. The universe consisted of 99 papers. Variables such as type of work, assistantship and those related to bibliographic references were evaluated. Descriptive statistics were used. Results: the Faculty of Medical Sciences "Dr. Zoilo E. Marinello Vidaurreta" was the institution with the highest number of papers in the event (76). A total of 238 participants were reported, with a predominance of multiple authorship in the papers, 69.75% were composed of 3 authors. The participation of internal medicine assistant students predominated (19). A total of 1945 bibliographic references were used, with an average of 19.65 references per paper. The PI was between 0.3 (case presentations) and 0.36 (originals). Conclusions: the XXXI Jornada Científica Estudiantil was characterized by the predominance of multiple authorship, female authors, outstanding participation of internal medicine assistant students, use of bibliographic references in Spanish in the reports, as well as a low Price index.

ABSTRACT Objective: To report the process of organization and construction of an information technology structure named Nursing Activities Score (NAS) Cloud Technology®. Method: This project was based on the life cycle theory and has enabled the development of technological production through software engineering. Results: The NAS Cloud Technology® was developed for remote and collaborative access on a website hosted by Google Sites® and protected in a business environment by the certified security and data protection devices Health Insurance Portability and Accountability Act (HIPPA). In 2015, this system received more than 10.000 submissions/month, totaling 12 care units for critical patients covered by the information technology structure, circa 200 nurses per day involved in the collection and hundreds of daily submissions, integrating the complete transition from paper to cloud. Conclusion: The development of NAS Cloud Technology® system has enabled the use of technology as a facilitating means for the use of Nursing care data, providing tools for decision-making on the nursing personnel sizing required for the care demands in the inpatient care units. The potential of cloud structures stands out due to their possibility of innovation, as well as low-cost access and high replicability of the information system.

Abstract: Promoting socioemotional skills has been highlighted among the evidence to prevent suicidal behavior in childhood and adolescence. This review aimed to map and analyze national and international scientific papers on initiatives and programs for the prevention of suicidal behavior in adolescence based on the theoretical framework of socioemotional skills. It is a scoping review using the methodology proposed by the Joanna Briggs Institute. Eleven academic bibliographic databases were analyzed, and searches were conducted on institutional websites related to suicide prevention and Google. Papers in Portuguese, Spanish, French, and English from 2010 to July 2022 were included in the review, which consisted of 97 studies, analyzed through data matrix and thematic grouping. The results show that most are international and focused on suicide, not on self-harm alone. In general, they have an informational and instructional bias for professionals, institutions, and governments, proposed laws, programs and action plans, studies on the role of socioemotional skills and intervention research. Few strategies have been clearly tested and validated. The key elements are the ability to perceive, recognize, understand, express, and regulate one’s own emotions, get motivated, and build empathy in relationships. Schools are key players in this process and the health system should act as a collaborative network. National and local prevention plans are required, emphasizing the role of schools, the health sector, and intersectoral coordination to promote health and quality of life.

Objective: To investigate the gender of the authors who publish articles of health economic evaluations in medicine and healthcare journals. Method: We evaluated a random sample of economic evaluations indexed in MEDLINE during 2019. Gender of the first, last and corresponding author was determined by review of the author's first name. Data were summarized as frequency and percentage for categorical items and median and interquartile range (IQR) for continuous items. We also calculated the index of authors per paper. Results: We included 200 studies with 1365 authors (median of 6 authors per paper; IQR: 4-9). Gender identification was possible for all authors in the study sample: 802 (59%) were men and 563 (41%) were women. The number of female first, last, and corresponding authors respectively were 78 (39%), 68 (34%), and 80 (40%) for health economic evaluations. Discussion: Female scientists were underrepresented as co-authors and in prominent authorship positions in health economic evaluations. This study serves as a call to action for the scientific community to actively work towards equity and inclusion. Resumen: Objetivo: Investigar el género de las personas autoras que publican artículos de evaluaciones económicas de la salud en revistas de medicina y atención sanitaria. Método: Se evaluó una muestra aleatoria de evaluaciones económicas indexadas en MEDLINE durante 2019. El género de las personas autoras como primera, última y autoría de correspondencia se determinó mediante la revisión del nombre de la persona firmante. Los datos se resumieron como frecuencia y porcentaje para las variables categóricas, y como mediana y rango intercuartílico (RIC) para las variables continuas. También se calculó el índice de autores por artículo. Resultados: Se incluyeron 200 estudios con 1365 autores (mediana de 6 autores por artículo; RIC: 4-9). La identificación del sexo fue posible para toda la muestra: 802 (59%) eran hombres y 563 (41%) eran mujeres. Los números de científicas con una posición como primera, última y autora de correspondencia fueron 78 (39%), 68 (34%) y 80 (40%), respectivamente, para las evaluaciones económicas. Discusión: Las científicas estuvieron infrarrepresentadas como coautoras y en puestos de autoría destacados en las evaluaciones económicas. Este estudio sirve como una llamada a la acción para que la comunidad científica trabaje activamente por la equidad y la inclusión.

This paper aims to provide a systematic review of the literature on school effectiveness, with a focus on identifying the main factors that contribute to successful educational outcomes. The research question that this paper aimed to address is “what are the main factors of school effectiveness?”. We were interested in several descriptors such as school, effectiveness/efficiency theories, effectiveness/efficiency research and factors. Studies (published within the 2016–2022 period) were retrieved through two databases: JSTOR and ERIC. This paper defines several categories identified by school effectiveness research. Within these categories, various factors that affect the students’ outcomes and the defined effectiveness in school are listed. As the results show, the issue of school effectiveness is multifaceted, as the effectiveness of schools is a complex concept that can be measured through various indicators such as academic achievement, student engagement and teacher satisfaction. The review of school effectiveness revealed that several factors contribute to effective schools, such as strong leadership, effective teaching practices, a positive school culture and parental involvement. Additionally, school resources, such as funding and facilities, can impact school effectiveness, particularly in under-resourced communities.

Background: original investigations represent the fulfillment of a research process; it test all the research team’s abilities, from detecting the problem and conducting the study to interpreting the results and proposing solutions to the problem.Objective: to characterize the original research presented at the COVID-19 First National Scientific Conference, CovidCien2021. Methods: an observational, descriptive, cross-sectional study was carried out. 57 papers presented at the event were included. Variables: number of original researches presented, student investigations or professional investigations, type of study, type of research, most common methodological errors, number of authors. Descriptive statistics were used for processing and analysis of the results.Results: 57 free topics were presented (32.6%). Research belonging to students stood out (32; 56.1%). Descriptive observational studies (50; 87.7%) and quantitative studies (50; 87.7%) stood out. Papers with four and five authors prevailed (14; 24.6%). Difficulties such as the absence of the research objective and errors in the methodology that make its reproduction impossible were observed.Conclusions: descriptive observational researches, mostly quantitative, provide general and particular elements of a problem. There is a need to educate future generations in good methodological practices, in order to achieve science of quality and excellence.

The Caribbean is experiencing a worsening epidemic of obesity and noncommunicable diseases (NCDs) and it has the worst rates of premature mortality from cardiovascular diseases in the region of the Americas. Creating enabling environments to improve dietary diversity would help reduce obesity and diet-related NCDs. The Improving Household Nutrition Security and Public Health in the CARICOM project aimed to increase dietary diversity in the Caribbean, and to determine and implement effective, gender-sensitive interventions to improve food sovereignty, household food security, and nutrition in CARICOM states. Primary quantitative and qualitative research, scoping reviews, stakeholder engagement, implementation of interventions and dissemination activities were undertaken. This paper describes the overall project design and implementation, discusses challenges and limitations, and presents core achievements to inform further work in Small Island Developing States throughout CARICOM to advance the nutrition agenda in the Caribbean. The results of the project’s research activities are presented in other papers published in this special issue on nutrition security in CARICOM states.

This paper addresses questions about the use of metacognitive strategies in argumentative writing based on multiple sources and the influence of this use on the quality of student texts. For this purpose, think-aloud protocols and texts from a research project on material-supported argumentative writing in 8th grade geography lessons are analyzed and discussed. The analysis is based on a model of metacognition in argumentative writing using multiple sources, which we also propose in this paper. The results show that the use of metacognitive strategies is a challenge for the investigated target group but that their use, in particular the deployment of goal-setting strategies and planning strategies, enables students to write better texts.

As the COVID-19 pandemic continues, university education and feedback guidance have inevitably moved to online platforms, becoming a global trend. This study focuses on a case of Sookmyung Women’s University in South Korea, which has operated an online discussion clinic for university general education for more than a year as a case study. There are two main research methods. A frequency analysis was conducted to confirm what kind of counseling the students preferred at the discussion clinic based on the answers written in the students’ applications. The students whose applications were used for the analysis were divided into 57 teams, and there were two to six members per team. The results were as follows: In the survey results, students wanted help with the preparation process necessary for the discussion and the practical strategies for facilitating discussions. They wanted personalized counseling, demonstrating that discussion education provided in the foundational curriculum is insufficient. Second, the educational model of the discussion clinic and educational examples were examined. The findings confirmed that online discussion education is effective if the system is technically supplemented. Instructors and researchers are prepared to meet students’ demands for feedback and individual counseling, even if these are not provided through face-to-face discussions. Additionally, face-to-face guidance can be operated more effectively by taking advantage of online systems. The findings also demonstrate that further research on designing and operating online discussion centers is required. This study is a preceding study on developing online systems and educational guidelines for higher educational institutions to present new insights into smart learning. This paper also includes suggestions for educational and scientific discussions. The online discussion instructional model shown in this paper explores methods of scientific communication through a debate on scientific issues.

HEARTS in the Americas is the regional adaptation of the World Health Organizations Global Hearts Initiative, which will be the model for risk management for cardiovascular disease (CVD) in primary health care in the Region of the Americas by 2025. It has already been implemented in 21 countries and 1045 primary health care centers throughout Latin America and the Caribbean. It takes a public health and health systems approach to systematically introduce simplified interventions at the primary health care level and focuses on hypertension as a clinical entry point. This paper introduces a new, improved application (app), the main component of which is the calculator for CVD risk and hypertension management. The paper summarizes the risk assessment approach and the methodology used by the World Health Organization to update its cardiovascular risk charts in 2019; describes the app, its use, functionality and validation process; and provides a set of practical recommendations for optimizing CVD risk and hypertension management by using the app in clinical practice. The HEARTS app is a powerful tool to improve the quality of care provided in primary health settings. The creation and dissemination of the HEARTS app is an essential step in the journey towards eliminating preventable CVD in the Americas.

Objectives. This paper describes and analyzes embedded implementation research and the empirical processes of planning for utilization, strategies to promote utilization and the sustainability of utilization of results from research led by decision-makers in Latin America and the Caribbean. Methods. This qualitative, descriptive and interpretive study is based on the findings from semistructured interviews with members of teams working under the Embedding Research for the Sustainable Development Goals initiative (2018–2019) as well as their responses to a self-assessment follow-up questionnaire 1 year after the project was completed. Results. Altogether 13 teams from 11 countries participated in the Initiative. Nine teams had a core team composed of a decision-maker as the principal investigator assisted by a researcher as co-principal investigator. Four teams included more than one co-principal investigator; and in five teams, the originally assigned principal investigator was replaced. There was an interesting relationship between the expected utilization of research results, the utilization strategies, the sustainability of research uptake and the teams’ collaboration modalities. When decision-makers and co-principal investigators were active participants, the intention to use the results and strategies for utilization were clearly oriented to improve implementation. In teams with basically a formal collaboration between the two principals, plans for utilization were unclear or focused on producing academic knowledge. The participation of implementers below the rank of principal investigator decision-maker may be relevant. Conclusions. Embedded implementation research is an innovative tool that may foster the utilization of research and strengthen health programs and services. Considering the internal dynamics of such research teams will enhance planning and strategies for research utilization as well as the sustainability of practical and actionable findings.

Research related to blockchain is rapidly gaining importance in the higher education. This opportunity collaborates with a proposal for a review of papers on the main blockchain topic. The bibliometric analysis included 61 peer-reviewed articles published in the Scopus database during the period of 2016 to 2021. This paper offers the identification of gaps in the literature enabling studies on the subject in higher education. The article identifies the main applications of blockchain technology in higher education around the world, as well as suggests future investigations. For further scientific investigation, we propose the operationalization of each of the researched approaches, especially combining the blockchain relationship, artificial intelligence, digital innovation, digital maturity, and customer experience in higher education.

Objective: To explore the typology of implemented salutogenic interventions and the health effects described by the authors. Method: A scoping review of the literature published (PubMed, Embase, Web of Science and Scopus) over the last ten years (2007-2016) was conducted. Articles that included interventions with assessments of health outcomes were selected for this review. The kappa index (86.4%) was calculated for the classification and extraction of information. Results: 61 papers were selected out of the 676 works identified. These were categorized into individual, grouped, mixed and intersectoral interventions. A total of 85% of the interventions described positive effects. Adverse effects were not reported. Methodological limitations were identified in 75% of the papers. The interventions addressed a large variety of topics, especially in the field of mental health and chronic diseases. Collective actions described more positive effects. Intersectoral actions were the only type of interventions to have approached the impact of mortality reduction. Conclusions: Findings support the existence of positive health effects of salutogenic approaches. Important methodological limitations were identified, such as biases in the selection of participants and sample sizes. Studies need to be conducted with improved monitoring and evaluation designs. A more robust theoretical framework and tools to evaluate the salutogenic contents are needed. Resumen: Objetivo: Conocer el tipo de las intervenciones salutogénicas identificadas en la literatura científica y los efectos descritos por los autores en la salud de la población. Método: Se realizó una scoping review de trabajos publicados entre los años 2007 y 2016 en español, inglés y francés en PubMed, Embase, Web of Science y Scopus. Se seleccionaron y clasificaron trabajos de investigación que contemplaran una intervención con evaluación de resultados en salud. Se calculó el índice kappa (86,4%) para la clasificación y la extracción de la información. Resultados: Se seleccionaron 61 trabajos de investigación entre 676 trabajos identificados. Se clasificaron en intervenciones individuales, grupales, mixtas e intersectoriales. El 85% de las intervenciones describieron efectos positivos. No se encontraron efectos adversos. Se observaron limitaciones metodológicas en el 75% de los trabajos. Las intervenciones abordaban gran variedad de temas, especialmente en el campo de la salud mental y las enfermedades crónicas. Las intervenciones colectivas describen más efectos positivos. Las actuaciones intersectoriales representan el único tipo de intervenciones que ha abordado el impacto en la reducción de la mortalidad. Conclusiones: Los hallazgos descritos sugieren la existencia de efectos positivos para la salud. Se identifican importantes limitaciones metodológicas. Es necesario desarrollar estudios en mejores condiciones de control, así como marcos teóricos más robustos y herramientas que permitan evaluar el contenido salutogénico de las intervenciones.

This paper highlights the important leadership role of the public health sector, working with other governmental sectors and nongovernmental entities, to advance environmental public health in Latin America and the Caribbean toward the achievement of 2030 Sustainable Development Goal 3: Health and Well-Being. The most pressing current and future environmental public health threats are discussed, followed by a brief review of major historical and current international and regional efforts to address these concerns. The paper concludes with a discussion of three major components of a regional environmental public health agenda that responsible parties can undertake to make significant progress toward ensuring the health and well-being of all people throughout Latin America and the Caribbean.

ABSTRACT OBJECTIVE To carry out a critical review of the literature on the use of race, color, and ethnicity in the field of public health dentistry. METHODS A literature search was conducted in MEDLINE via PubMed for articles published between 2014 and 2019. Using a data extraction form, we collected information on (1) bibliographic characteristics of the selected papers; (2) race, color, and ethnicity of the study participants and their sociodemographic profiles; and (3) the extent to which the original publications followed the recommendations by Kaplan and Bennett (2003) on the use of race, color, or ethnicity in biomedical research. RESULTS Our initial search identified 2,032 articles, 53 of which were selected for full-text examination and assessment following pre-established eligibility criteria. Around 60% (n = 32) of the included studies did not justify the use of race, color, or ethnicity in their analyses, and 9% (n = 5) took these variables as indicators of the participants’ genetic makeup. On the other hand, 68% (n = 36) of the reviewed papers considered race, color, and ethnicity as risk markers – not risk factors – for adverse oral health outcomes, whereas 80% (n = 42) adjusted racial/ethnic inequities for a range of socioeconomic and demographic factors in statistical models. Only one study (2%) explicitly took race, color, or ethnicity as a contextually dependent dimension of the participants’ identities. CONCLUSION Our findings indicate that research on oral health inequities is often based on reductionist and stigmatizing conceptions of race, color, or ethnicity. Such harmful misconceptions should be replaced with anti-racist narratives in order to effectively address racial oral health inequities.

(1) Background: This paper presents an analysis of the associations between minority stressors and activism in the population of lesbian, gay, and bisexual individuals in Poland. (2) Methods: The cross-sectional online-based research was conducted among 192 lesbian, gay, and bisexual (LGB) people in two groups: activists (n = 51) and people not engaged in activism (n = 141). Four scales of the Sexual Minority Stress Scale were used: Internalized Homophobia, Expectation of Rejection, Concealment, and Sexual Minority Negative Events Scale. Activism was measured using the Activism Scale and a single item asking about belonging to an activist group. (3) Results: Activists, lesbians, and gays scored significantly higher in the Sexual Minority Negative Events than people not involved in activism and bisexual individuals. Attitude toward LGBT+ activism correlated weakly and positively with Sexual Minority Negative Events and Expectation of Rejection while negatively with Internalized Homophobia. The Network Analysis showed that positive attitudes toward LGBT+ activism, the expectation of rejection, and negative events in minority stress are the most influential variables in the network model, playing a crucial role in the interaction between particular dimensions of minority stress. (4) Conclusions: Prevention and intervention programs should focus on reducing minority stress, especially negative events and rejection, especially among lesbians, gays, and people engaged in LGBT+ activism. The cooperation of politicians, lawyers, social workers, and psychologists is required to decrease homophobia and the stigmatization of people representing sexual and gender minorities.

Introduction. Perinatal loss is a profoundly stirring event that affects various areas of society, from women and their partners to health professionals and society as a whole. Unfortunately, in caring for women experiencing perinatal bereavement, information and support related to breastfeeding is often overlooked, which can increase their feelings of grief and anxiety. However, breast milk donation has been recognised as a valuable option that can play a significant role in the bereavement process. Aim. To review the existing literature on the impact of milk donation after perinatal loss, its role in the bereavement process and its implications. Methods. Literature search of PubMed, Cochrane and PsycINFO databases to identify studies addressing milk donation, perinatal loss and women’s experiences. Results. Based on seven qualitative papers, they highlighted the need for breastfeeding support for mothers in perinatal bereavement, as well as the lack of sensitive and non-judgmental communication by health professionals. Conclusion. Breastfeeding can play an essential role in the perinatal bereavement process, validating maternal identity and generating meaningful memories. The importance of addressing breastfeeding inhibition on an individualised basis and improving the training of health professionals to provide comprehensive support is emphasised.

The prevalence of diagnosed cases of autism has increased rapidly, which has raised interest in studying the variables related to the well-being of these families. The purpose of this paper is to review the recent literature on other variables related to family well-being, such as parenting styles. We conducted a systematic review using the PRISMA check list and bias assessment with the aim of analyzing if the concepts of autism, well-being and parenting style are related. We screened 755 references from relevant databases like Scopus, Pubmed, PscyInfo EBSCO, Web of Science and Dialnet, updated on May 2024. Sixteen full text articles and abstracts were read. It was identified that the authoritative parenting style, as well as those based on warmth, establishing relationships and emotional bonding, and low expressed emotion were positively related to family well-being. On the other hand, authoritarian, permissive and overprotective styles, as well as critical, punishing and training-based, were negatively associated with well-being and quality of family life.

The aim of this paper is to analyze the formative and evaluative activities involving statistical graphs in the new textbooks for Chilean rural multigrade education. The methodology is qualitative, at a descriptive level and uses the content analysis technique. The sample is made up of the six primary education textbooks distributed by the Ministry of Education for rural multigrade schools. The results show the predominance of the bar chart, semiotic level 3, the task of calculating and the personal context in both types of activities, although with respect to the reading level, it is evident that level 4 predominates in the formative activities and level 2 in the evaluative ones. According to the results, it is recommended to incorporate graphs proposed by the curricular guidelines of the Ministry of Education, which are absent in textbooks as well as to include evaluative activities that require reflection on the nature of the data, context, representation and conclusions obtained from them.

Introduction: Although gifted children can express high cognitive skills, they can also show socioemotional difficulties. Drawing from Olson’s circumplex model, the present paper assessed the role of family functioning in internalizing and externalizing problems in gifted children. Materials and Methods: 362 mothers and their 362 gifted children were included. The unbalanced subscales of the FACES IV—disengagement, enmeshment, rigidity, and chaos—and the CBCL were administered to mothers. The children completed the WISC-IV. Results: The model predicting internalizing problems was significant and explained 5.6% of the variance. Only rigidity had an independent and positive effect on internalizing problems in gifted children over and above sociodemographic variables and QI, whereas disengagement, enmeshment, and chaos were not associated with internalizing problems. The model predicting externalizing problems was significant and explained 10% of the variance. Again, rigidity was the only variable that had an independent and positive effect on externalizing problems in gifted children over and above sociodemographic variables and QI, whereas disengagement, enmeshment, and chaos were not associated with externalizing problems in this population. Discussion: Rigid families with a low ability to change in conditions that require readjustment appear to increase the risk of both internalizing and externalizing problems in gifted children. Although further studies are needed to support these preliminary findings, parental support interventions aimed at increasing flexibility appear to be useful.

This paper examines potential associations of loneliness with laboratory data and specific psychosocial and behavioral attitudes. The sample collection took place in an urban Primary Health Care unit between May and July 2023, consecutively, and once exclusion criteria were implemented. Participants were aged between 40 and 75 years. Routine laboratory test results upon study initiation and six months before were used. The University of California, Los Angeles (UCLA), Loneliness Scale (Version 3), blood glucose, serum lipids, Fibrosis-4 index, and Creatinine Clearance (CrCl) were assessed through hierarchical multiple logistic regression analysis. Based on full model (3rd) analysis, those who were engaged in an individual sport or activity or had contacts with more friends presented significantly lower odds for increased loneliness levels (odds ratio (OR): 0.28 [95% confidence interval (CI) 0.09–0.91], p = 0.034 and OR: 0.76 [95%CI 0.66–0.88], p < 0.001, respectively). The consumption of alcohol was associated with increased loneliness (OR: 5.55 [95%CI 1.42–21.63], p = 0.014). Elevated triglyceride levels were linked with moderate or no loneliness (OR: 0.20 [95%CI 0.05–0.83], p = 0.026), while an increased LDL/HDL atherosclerotic index was related to increased subjective loneliness (OR: 4.50 [95%CI 1.12–18.13], p = 0.035). The need for holistic approaches—involving primary care personnel—in understanding and addressing loneliness, recognizing its multifaceted nature as well as the diverse factors that contribute to this issue, is considered challenging.

The Pan American Health Organization (PAHO) and its Member States have been leading the efforts to eradicate wild poliovirus in the Region of Americas since smallpox's successful elimination in 1971. The region became the first to be certified free of wild poliovirus in 1994. However, in July 2022, an unvaccinated patient with no recent travel history was diagnosed with poliomyelitis in the United States of America. In response to the emergence of a circulating vaccine-derived poliovirus in the United States, PAHO established the Polio Incident Management Support Team. This team has been coordinating response efforts, focusing on: coordination, planning, and monitoring; risk communication and community engagement; surveillance and case investigation; vaccination; and rapid response. In this paper, we identified and documented best practices observed following establishment of the Incident Management Support Team (September 2022–2023) through a comprehensive review and analysis of various data sources and country-specific data from the polio surveillance dashboard. The aim was to share these best practices, highlighting technical support and implementation of polio measures by Member States. Despite several challenges, the Americas region remains polio-free. Polio risk is declining, with a July 2023 assessment showing fewer countries at medium, high, and very high risk. This progress reflects improved immunization coverage, surveillance, containment, health determinants, and outbreak preparedness and response. The PAHO Polio Incident Management Support Team has played a key role in supporting these efforts.

Resumen: La economía del comportamiento (que aúna economía y psicología) ofrece claves para entender las decisiones tomadas por dirigentes políticos y por la ciudadanía durante la pandemia de COVID-19 a través de los llamados sesgos cognitivos. Estos sesgos pueden ser contrarrestados mediante intervenciones conductuales, denominadas nudges, para promocionar conductas responsables en la «nueva normalidad». Además de repasar, desde la óptica de la economía del comportamiento, el pasado, el presente y el futuro de los elementos conductuales que rodean a la pandemia y su gestión, este artículo propone la formalización jurídica de los nudges, para lo cual deben cumplirse tres estándares mínimos: la exigencia de transparencia, la proscripción de la arbitrariedad y la puesta en valor de su eficiencia. Sugerimos, de igual forma, diseñar protocolos para futuras pandemias, de suerte que los nudges y las medidas legislativas duras puedan complementarse de una manera armónica y escalonada. Los nudges se prestan a una implementación rápida y poco coercitiva, por lo que resultan especialmente apropiados en orden al encauzamiento de las conductas más leves, pudiendo así reservarse otras medidas, como las sanciones, para las situaciones más graves. Abstract: Behavioural economics (a combination of economics and psychology) provides keys to understand decisions made by politicians and citizens along the COVID-19 pandemic through the so-called cognitive biases. These biases can be offset by implementing behavioural interventions named “nudges” in order to promote responsible behaviours in the “new normality”. This paper analyses, from a behavioural economics perspective, past, present and future of behavioural aspects surrounding the pandemic. Besides, this paper proposes different ways to formalize nudges according to law, which needs the fulfilment of three minimum requirements, namely: transparency, non-arbitrariness and efficiency. Furthermore, it is also suggested that protocols and contingency plans are set up to face future pandemics, in which both soft (nudge-type) interventions and hard legal regulations play different roles but complementary ones. Nudges can be implemented in a fast and less coercive way, so they are particularly suitable for changing mild misbehaviour, reserving legal sanctions for the more serious ones.

Abstract: Since May 2020, we have been conducting a comprehensive study to understand the natural history of SARS-CoV-2 infection in Rio de Janeiro, Brazil. Our focus has been on following families, systematically collecting respiratory tract swabs and blood samples, monitoring symptoms, and gathering data on vaccine status. This paper aims to describe the household cohort across five epidemic waves of SARS-CoV-2, providing an overview of the collected data and a description of the epidemiological, clinical, and immunological characteristics and incidence of SARS-CoV-2 infection. Our cohort includes 691 participants from 189 households. During the five epidemic waves, we detected 606 infections. The incidence density of SARS-CoV-2 infection ranged from 4 (Delta) to 56 (B.1.1.33) per 1,000 person-week, with a peak in wave B.1.1.33 in all age groups. The seroprevalence of SARS-CoV-2 antibodies (IgG anti spike protein) varied from 37%, in the pre-VoC period, to 99%, in the Omicron period, progressively increasing after each wave in a similar manner regardless of age. As we have monitored the cohort continuously since the beginning of the pandemic, we were able to collect data across different scenarios according to the predominant lineage in circulation. Via active monitoring of families, we were able to carry out an epidemiological surveillance on SARS-CoV-2, including its variants, persistence of symptoms, and changes in immunity over time in the population, contributing to knowledge of the natural history of SARS-CoV-2 infection.

More than 8 million older people in Latin America depend on long-term care (LTC), accounting for 12% of people aged ≥ 60 years and almost 27% of those aged ≥ 80. It is crucial to develop sustainable strategies for providing LTC in the area, including institutional care. This special report aims to characterize institutional LTC in four countries (Brazil, Chile, Costa Rica and Mexico), using available information systems, and to identify the strategies adopted to support institutional care in these countries. This narrative review used nationwide, open-access, public data sources to gather demographic estimates and information about institutional LTC coverage and the availability of open-access data for the proportion of people with LTC needs, the number of LTC facilities and the number of residents living in them. These countries have a larger share of older people than the average in Latin America but fewer LTC facilities than required by the demand. National surveys lack standardization in defining disability, LTC and dependency on care. Information about institutional care is mainly fragmented and does not regularly include LTC facilities, their residents and workers. Data are crucial to inform evidence-based decisions to favor prioritization and to support advances in promoting policies around institutional LTC in Latin America. Although information about institutional care in the region is fragmented and insufficient, this paper profiles the four selected countries. It highlights the need for a better structure for datadriven LTC information systems. The lack of information emphasizes the urgency of the need to focus on and encourage research into this topic.

The purpose of this paper is to delve into the ethical aspects experienced by the healthcare team when they receive the directive to limit therapeutic effort or a do-not-resuscitate order. From an interpretative, qualitative paradigm with a content analysis approach, a process based on three phases was conducted: pre-analysis in which categories were identified, the projection of the analysis, and inductive analysis. During 2023, interviews were conducted in the clinical setting of a high-complexity hospital in Chile with 56 members of the healthcare teams from critical and emergency units, from which four categories emerged: a) the risk of violating patients’ rights by using do-not-resuscitate orders and limiting therapeutic effort; b) the gap in the interpretation of the legal framework addressing the care and attention of patients at the end of life or with terminal illnesses by the healthcare team; c) ethical conflicts in end-of-life care; and d) efficient care versus holistic care in patients with terminal illness. There are significant gaps in bioethics training and aspects of a good death in healthcare teams facing the directive to limit therapeutic effort and not resuscitate. It is suggested to train personnel and work on a consensus guide to address the ethical aspects of a good death.

Abstract: Although food insecurity presents a decreasing trend worldwide, some regions recently observed an increase in hunger levels. Such was the case in Brazil between 2014 and 2018, during and after the great Brazilian recession, and between 2020 and 2021, during the COVID-19 pandemic. This paper describes the evolution of food insecurity in Brazil between 2004 and 2022 using Brazilian National Household Sample Survey (PNAD), Brazilian Household Budget Survey (POF) and Continuous PNAD. Households were classified in 20 types of arrangements, and the most vulnerable living arrangements between 2004 and 2018 were identified by multinomial logistic models. Overall, households headed by women (single blacks, whites or in couples) with or without children were the most prone to food insecurity. As for the evolution of food insecurity in Brazil between 2018 and 2022, logistic models were applied to estimate moderate and severe food insecurity levels among the 20 household types. Additionally, effects of the emergency aid and idiosyncrasies of the COVID-19 pandemic were estimated.

This paper reviewed the most effective strategies for preventing work absence due to back pain (BP) and BP episodes (the number of people reporting back pain). We searched randomized controlled trials (RCTs) of prevention strategies for BP from previous meta-analyses, PubMed, CENTRAL, and Embase and conducted a network meta-analysis. Thirteen RCTs (2033 participants) were included. Low- to high-quality evidence showed that exercise combined with ergonomics, education, back belts, and education combined with ergonomics did not prevent sickness absenteeism or BP episodes. There was moderate-quality evidence that exercise, especially resistance exercise, was the best prevention strategy to reduce the number of people reporting absenteeism due to BP (risk ratio [RR] = 0.10; 95% CI: 0.01 to 0.69). Moderate-quality evidence suggested that resistance and stretching exercises combined with education was the best prevention strategy to reduce pain (RR = 0.80; 95% CI: 0.67 to 0.96) and the number of absenteeism days for BP (standardized mean difference [SMD] = −0.39; 95% CI: −0.77 to −0.02). In conclusion, exercise, especially resistance and stretching exercises, and exercise combined with education were ranked as the best interventions to prevent sickness absenteeism and BP episodes.

Background: In this paper, a Mexican Optimism Scale was constructed to investigate and estimate psychometric properties (reliability and validity based on the measurement model). The convergent validity and validity criterion were evaluated for a sample of young Mexicans. Methods: The scale was presented to 848 Mexican young people aged between 17 and 30 years from three different regions of Mexico. The scale was reduced to 20 items on the basis of CFA and analyses of internal consistency. Results: The confirmatory factor analysis (CFA) suggested a three-factor structure of optimism: affective resources, positive vision and hope. The data provided evidence for convergent validity with positive affect, negative affect and coping. Additionally, males scored higher on affective resources and positive vision than females. Finally, the results support the reliability of the instrument. Conclusions: The psychometric properties of the Mexican Optimism Scale proved to be highly acceptable and allow for a novel assessment of optimism from an ethnopsychological perspective. Validity, reliability and invariance were determined, as well as percentiles for the practical use of the scale. This scale may be of crucial importance for future research on optimism and health.

Towards the language analysis performed on two recommendations issued by the local human rights commission located in San Luis Potosí, México, this paper pretends to uncover the institutional dimension of obstetric violence which acts on a local level of health authorities. The analysis stands by a concept of obstetric violence as a systematic violences accumulation committed on the women’s bodies produced by an (undiminished) hospital-structural failure; but also, a poor performs on the medical state public services affected by the communitarian and political life of those women. This analysis also involves the human rights dimension of women on this form of violence, which stands on the before said, local level of healthcare public system. The research was structured with a qualitative approach through the selection of secondary information sources towards two recommendations issued by the human rights’ local authority. The information sources were purely based on the content of the violations present on each document, taking on consideration the human right gross violations and the quality of the recommendations.

Pregnant people with coronavirus disease 2019 (COVID-19) have a higher risk of adverse maternal and fetal outcomes compared with pregnant people without COVID-19. In 2021, large increases in maternal mortality were reported in Jamaica, almost half of which were attributable to COVID-19. COVID-19 vaccination has been shown to reduce these risks, but low- and middle-income countries lack free, publicly available data, known as open data, on COVID-19 vaccine uptake for their pregnant populations. The objectives of this paper were to: review how high-income countries use open data to detect trends in COVID-19 vaccine uptake among pregnant people and develop vaccination distribution strategies; outline barriers to making open data available for maternal COVID-19 vaccination in the Caribbean; and propose a multipronged strategy that would increase the availability of open data on maternal COVID-19 vaccination in the Caribbean. A multipronged strategy to fill the data void would involve: (i) utilizing existing Caribbean maternal immunization data collection entities; (ii) adapting digital software tools to establish maternal electronic immunization registries; and (iii) collaborating with local partners skilled in data analytics. Making open data available for COVID-19 vaccine uptake among pregnant people in the Caribbean could offer substantial benefits, including the development of measurable maternal COVID-19 vaccination goals and the facilitation of vaccine decision-making discussions between providers and pregnant people.

School bullying or bullying is a social problem that has increased in such a way that it represents a worldwide concern, from which Cuba is not exempt. This paper reflects on the conditions and risks that can generate negative consequences in vulnerable people to suffer this type of aggression. Depression, anxiety and certain physical and social conditions stand out in those affected and, among these, the suffering from obesity that could increase, as a cumulative risk, sleep disorders in children and adolescents. A review was carried out about the possible impacts of linking obesity and bullying in terms of sleep disorders in children and adolescents. It is concluded that there is an association between obesity, bullying and the risk of suffering from sleep disorders, which, fundamentally from Primary Health Care, should be considered so that the corresponding protocols can be detected and applied to this population at risk and its environment, for which psycho-pedagogical actions and intersectoral coordination are recommended.

Organized sports programmes offer manifold opportunities for learning and personal development. Prisoners in organized sports programmes could profit from these educational opportunities, which could eventually support their process of reintegration into society. However, research on the educational experiences of imprisoned individuals during organized sports activities is scarce. Using quantitative survey data (N = 568 adult male prisoners) collected within the scope of the Hessian Prison Sports Study in Hesse, Germany, the present study examines educational experiences that are instigated through participation in five different prison sports programmes (fitness, racket, and team sports, running groups, and strength training). The results show that participants reported few educational experiences. The most common experiences reported were learning to exert effort and acquiring health-related knowledge. The findings reveal distinct patterns for specific sports programmes. For instance, team sports more frequently address cooperation skills and fairness. This paper advocates for more attention to the educational potential of sports in prison settings, where sports outcomes should be better aligned with the desired educational outcomes.

In a recent paper, the first version of the contemporary psychometrics (ConPsy) checklist for assessing measurement tool quality has been published. This checklist aims to provide guidelines and references to researchers to assess measurement properties for newly developed measurement instruments. The ConPsy checklist recommends appropriate statistical methods for measurement instrument evaluation to guide researchers in instrument development and to support peer review. In this opinion article, I critically review some aspects of the checklist and question the usefulness of certain psychometric analyses in research practice.

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children’s use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021’s National Survey of Children’s Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent’s U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of “other” race/ethnicity, younger parent age, enrolled in health insurance, and parent’s U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper’s conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children’s physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants’ traditional health-related beliefs, showing cultural competence.

For many adolescents and young adults, gambling can represent an attractive and exciting form of entertainment, a way to take risks and explore new experiences. However, gambling also poses a significant risk for this age group. Research suggests that adolescents and young adults are particularly vulnerable to the negative consequences of gambling, including addiction, financial difficulties, and mental health issues. This paper aims to critically examine data on adolescent and young adult gambling, focusing on the risk factors associated with gambling behavior. A total of 326 subjects (Mage = 19.01; SD =2.72), of whom 65.5% were female, completed a protocol containing a demographic sheet, the Lie/Bet Questionnaire, the Seven Domains Addiction Scale (7DAS), a subscale of the Addictive Behavior Questionnaire and the Coping Inventory for Stressful Situations (CISS). Specifically, we explored the impact of sociodemographic, environmental, psychological, and cognitive factors on adolescent and young adult gambling behavior. Clinical implications and future directions are discussed.

Resumen: La escasez de enfermeras es un fenómeno multicausal que afecta a todos los países y actualmente es una preocupación mundial. La infradotación de enfermeras pone en riesgo la sostenibilidad de los sistemas sanitarios y los resultados de salud de las personas. En España, históricamente no ha habido dificultades para atraer a nuevas generaciones de enfermeras. El déficit de enfermeras en España se explica por unas condiciones laborales precarias y una falta de desarrollo profesional que han provocado episodios de elevada migración internacional y abandono de la profesión. En este artículo se pone el foco en la evolución de diferentes indicadores de condiciones laborales de las enfermeras no especializadas, que son el grueso de la profesión. Estos indicadores permiten analizar el abandono de la profesión, la duración de los contratos, la dedicación a tiempo parcial o completa, y el abuso en la sobrecontratación. Se analizan los efectos de la COVID-19 y de la reforma laboral sobre estos indicadores. La COVID-19 redujo el abandono de la profesión y actualmente está en su cota más baja, y ha acelerado la necesidad de mejorar las condiciones laborales aumentando el porcentaje de contratos indefinidos y reduciendo la multiplicidad de contratos en un mismo mes. La reforma laboral ha ayudado a reducir el porcentaje de contratos temporales hasta situarse alrededor del 80% del total de los contratos, y ha reducido el número de enfermeras en España con más de un contrato en un mismo mes hasta situarse por debajo de las 3000 enfermeras de manera mantenida. Abstract: The nursing shortage is a multi-causal phenomenon that affects all countries and currently a global concern. The shortage of nurses jeopardizes the sustainability of health systems and the population health outcomes. Spain has historically had no difficulties in attracting new generations of nurses. The shortage of nurses is caused by the precarious working conditions and lack of professional development that have led to episodes of high international migration and abandonment of the profession. In this paper we focus on the evolution of different indicators of the working conditions of non-specialist nurses, who make up the bulk of the profession. These indicators allow us to analyse the abandonment of the profession, the duration of contracts, their full-time or part-time dedication and the excessive hiring. We have analysed the effect of COVID-19 and the labour reform on these indicators. COVID-19 reduced the abandonment of the profession and is currently at its lowest level, it has also accelerated the need to improve working conditions by increasing the percentage of permanent contracts and reducing the multiplicity of contracts in the same month. The labour reform has helped reduce the percentage of temporary contracts until reaching around 80% of the total contracts, and has reduced the number of nurses in Spain with more than one contract in the same month to below 3000 nurses on a sustained basis.

Resumen: Los desequilibrios recurrentes entre oferta, demanda y necesidades de personal son uno de los principales retos del Sistema Nacional de Salud (SNS). Esta situación tiene su origen tanto en factores de oferta como en los condicionantes de la demanda de recursos humanos en el sector público sanitario. La estructura demográfica de los profesionales sanitarios del SNS está generando un creciente número de salidas de médicos y enfermeras. Por otro lado, la compleja arquitectura institucional de la sanidad pública produce disfunciones en la estructura de la demanda y en la forma de contratación. En este trabajo se argumenta sobre la necesidad de articular una respuesta estratégica que aborde la mejora de la gobernanza de los recursos humanos del SNS y la reforma de los instrumentos de coordinación y armonización de las actuaciones en los tres niveles de gobierno de la sanidad pública. Abstract: Recurrent imbalances between supply, demand and personnel needs are one of the main challenges facing the National Health System (NHS). This situation has its origin both in supply factors and in the conditioning factors of the demand for human resources in the public health sector. The demographic structure of the NHS health professionals is generating an increasing number of outflows of doctors and nurses. On the other hand, the complex institutional architecture of the public health system produces dysfunctions in the structure of demand and in the form of recruitment. This paper argues for the need to articulate a strategic response that addresses the improvement of the governance of the human resources of the NHS and the reform of the instruments of coordination and harmonization of actions at the three levels of government of public healthcare.

Resumen: El sistema sanitario público español está saturado. Como consecuencia de ello, los profesionales sanitarios muestran síntomas de burnout o desgaste profesional, y la sanidad privada está creciendo más que nunca. Con las numerosas huelgas del colectivo médico se ha revelado la necesidad de que mejoren sus condiciones laborales y económicas, así como su frustración al no poder dedicar el tiempo y la calidad necesaria a los pacientes. Ante esta situación, la respuesta institucional en la mayoría de las comunidades autónomas ha sido suprimir la cláusula de exclusividad que garantizaba un sueldo mayor a cambio de la plena dedicación de los médicos al sector público, pero manteniendo el pago extra. Promover la práctica dual público-privada de los médicos permite que estos tengan más ingresos, pero plantea otras muchas cuestiones que intentamos analizar en este artículo, en el que también discutimos sobre otras medidas y reformas necesarias y urgentes, de mayor calado, que deberían ser abordadas por el gobierno para revertir esta situación tan crítica de nuestro sistema sanitario. Abstract: The Spanish public health system is overburdened. As a result, heath care professionals are showing symptoms of burnout, while private health services are expanding more than ever. As revealed by numerous strikes in recent years, health care professionals want better pay and work conditions and feel frustrated by their inability to give proper time and care to their patients. The institutional response from regional governments in Spain has been to remove the exclusivity clause that provided a salary bonus for physicians who worked entirely in the public sector; now all physicians receive this bonus, effectively promoting dual (public and private) practice. Although dual practice may increase the income of physicians and other health professionals, it poses several challenges that are analyzed in this paper. We also discuss alternative and more far-reaching policies that we believe should be implemented by the government in order to deal with the current crisis of the health system.

Resumen: Los problemas que plantea la formación médica en España son diversos. En este trabajo se analiza el sistema actual de acceso de los estudiantes a los estudios de medicina en las universidades públicas y algunas de las cuestiones que suscita el inusitado aumento de facultades de medicina, públicas y privadas, en nuestro país. La importancia de las competencias genéricas en la medicina actual y la necesidad de retomar el diseño troncal en la formación de especialistas son otros de los aspectos que se comentan. También es objeto de análisis el grado de desarrollo de los diplomas de acreditación avanzada y las áreas de capacitación específica. Finalmente, se subrayan la importancia del desarrollo profesional continuo y la idea de recertificación profesional como sistema que garantiza al paciente la calidad de la asistencia que recibe. Abstract: The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty of medicine in Spain and some issues arising from the unprecedented increase in both public and private medical schools in our country. The importance of generic competencies in today's medicine and the need to return to a core design in specialist training are other aspects that are discussed. The degree of development of advanced accreditation diplomas and areas of specific competence is also subject to analysis. Finally, the authors emphasize the importance of continuous professional development and the idea of professional recertification as a system that guarantees patients the quality of the care they receive.

Resumen: Las últimas crisis sanitarias han puesto de manifiesto la debilidad de las estructuras de salud pública en España. Las causas son, entre otras, la escasez de recursos económicos y el retraso en su modernización institucional, junto a la debilidad de los procesos formativos y de la empleabilidad. La Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) ha impulsado la elaboración del Libro blanco de la profesión de salud pública con el objetivo de contribuir a fortalecer el ejercicio profesional. Para ello se han descrito las características sociodemográficas de las asociaciones federadas a SESPAS y se ha analizado el discurso de los profesionales a través de seis grupos focales y 19 entrevistas en profundidad (72 personas). Con este material se realizó una reunión (29 personas) para consensuar conclusiones y recomendaciones. De las 3467 personas pertenecientes a las siete sociedades de SESPAS que proporcionaron datos, alrededor del 60% son mujeres y el 40% tienen menos de 50 años, siendo los estudios de grado de medicina (35,9%), enfermería (17,4%), farmacia y veterinaria (10,4%) los más frecuentes. En las entrevistas y grupos focales se identificaron como temas centrales la formación, la empleabilidad y la carrera profesional. En la reunión final se acordaron 25 conclusiones y 24 recomendaciones que pretenden contribuir a fortalecer a los/las profesionales y la profesión de la salud pública en España. Las relacionadas con la formación, la empleabilidad y la carrera profesional fueron compartidas en un Encuentro en la Escuela de Salud Pública de Menorca con responsables de salud pública del Ministerio de Sanidad y de algunas comunidades autónomas. Abstract: The recent health crises have highlighted the weakness of public health structures in Spain. The causes are, among others, the scarcity of economic resources and the delay in their institutional modernization. In addition, there is the weakness of the training processes and the employability. The Spanish Society of Public Health and Health Administration (SESPAS) has developed a White paper of the public health profession with the aim of contributing to strengthening professional practice. The sociodemographic characteristics of the associations federated to SESPAS have been described and the discourse of professionals has been analyzed through six focus groups and 19 interviews (72 people). To agree on the conclusions and recommendations, a meeting was organized with the participation of 29 participants. The demographic and employment data of the 3467 people belonging to seven SESPAS societies show that, overall, about 60% are women and 40% were under 50 years of age. Undergraduate degrees were medicine (35.9%), nursing (17.4%) and pharmacy and veterinary medicine (10.4%). Key aspects of the meaning of public health, training, employability and career and institutionalization of public health were collected through interviews and focus groups. The final meeting agreed on 25 conclusions and 24 recommendations that aim to contribute to strengthening professionals and the public health profession in Spain. Some of them, related to training, employability and professional career, have been shared in a workshop at the School of Public Health of Menorca with public health officials from the Ministry of Health and some autonomous communities.

Recently, the emerging technologies have been constantly shaping the education domain, especially the use of artificial intelligence (AI) for language learning, which has attracted significant attention. Many of the AI tools are being used for learning foreign languages, in both formal and informal ways. There are many studies that have explored the potential of the recent technology “ChatGPT” for education and learning languages, but none of the existing studies have conducted any exploratory study for assessing the usability of ChatGPT. This paper conducts an assessment for usability of ChatGPT for formal English language learning. The study uses a standard questionnaire-based approach to ask participants about their feedback for usefulness and effectiveness of ChatGPT. The participants were asked for their feedback after performing series of tasks related to formal English language learning with ChatGPT. A variety of student participants were selected for this study with diverse English language proficiency levels, education levels, and nationalities. The quantitative analysis of the participant responses shed light on their experience with regards to the usability of ChatGPT for performing different English language learning tasks such as conversation, writing, grammar, and vocabulary. The findings from this study are quite promising and indicate that ChatGPT is an effective tool to be used for formal English language learning. Overall, this study contributes to the fast-growing research domain on using emerging technologies for formal English language learning by conducting in-depth assessment of usability for ChatGPT in formal English language learning.

In the English-speaking Caribbean, an estimated 46% of men and 61% of women are currently overweight or obese, and 8% of children younger than 5 years are also overweight. To combat this worsening epidemic, driven by unhealthy dietary patterns, the Heads of Government of the Caribbean Community (CARICOM) issued the 2007 Port-of-Spain Declaration, which included mandates on the provision of healthy school meals, promotion of healthy dietary patterns, and reintroduction of physical education in schools. These mandates are aligned with evidence-based approaches used in childhood obesity prevention programs. School-based interventions, including curriculum revisions, are part of a multipronged approach to improve nutrition in children and are designed to complement and reinforce other interventions in schools. However, formal evaluation of the Port-of-Spain Declaration showed that most CARICOM member countries had difficulty implementing the mandates related to schools and diet. The Improving Household Nutrition Security and Public Health in the CARICOM project, in collaboration with regional institutions, the CARICOM Secretariat, and the Caribbean Examinations Council, sought to enhance nutrition education through revision of region-wide primary and secondary school curricula to increase the focus on prevention of noncommunicable diseases. This paper describes the process of revising the Caribbean Examinations Council’s Human and Social Biology syllabus for secondary schools and the CARICOM Health and Family Life Education Regional Curriculum Framework for primary schools, which was achieved through multisectoral collaboration. We used the Framework for Reporting Adaptations and Modifications-Enhanced model to describe the process through which the modifications were made.

Objectives. The aim of this initiative was to assess whether a novel training program – Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills – could improve primary health care providers’ confidence in the quality of mental health care they provide in the Caribbean setting by using the Plan-Do-Study-Act rapid cycle for learning improvement. Methods. We conducted a prospective observational study of the impact of this training program. The training was refined during three cycles: first, the relevance of the program for practice improvement in the Caribbean was assessed. Second, pilot training of 15 local providers was conducted to adapt the program to the culture and context. Third, the course was launched in fall 2021 with 96 primary care providers. Pre- and post-program outcomes were assessed by surveys, including providers’ confidence in the quality of the mental health care they provided, changes in stigma among the providers and their use of and comfort with the tools. This paper describes an evaluation of the results of cycle 3, the official launch. Results. A total of 81 participants completed the program. The program improved primary care providers’ confidence in the quality of mental health care that they provided to people with lived experience of mental health disorders, and it reduced providers’ stigmatization of people with mental health disorders. Conclusions. The program’s quality improvement model achieved its goals in enhancing health care providers’ confidence in the quality of the mental health care they provided in the Caribbean context; the program provides effective tools to support the work and it helped to empower and engage clients.

Objective. To map geographic clusters of rare disorders and congenital anomalies reported in South America. Methods. Qualitative systematic review conducted in Medline/PubMed, Lilacs, and Scielo electronic databases to identify studies meeting eligibility criteria. The strategy resulted in 1 672 unique articles, from which 164 were selected for full reading by a pair of reviewers. Results. Fifty-five articles reported at least one cluster of genetic disorders or congenital anomalies in South American territory. From these papers, 122 clusters were identified, of which half (61) were related to autosomal recessive disorders. Sixty-five (53.3%) of the clusters were located in Brazil. Conclusions. The results of the review reinforce that rare diseases and congenital anomalies can occur in a non-random way in space, which is discussed in the perspective of the complex history of formation, social organization, and genetic structure of the South American population. Mapping clusters in population medical genetics can be an important public health tool, given that such places concentrate cases of rare diseases that frequently require multiprofessional, specialized care. Therefore, these results can support important agendas in public health related to rare diseases and congenital anomalies, such as health promotion and surveillance.

The smartphone has become integral to most aspects of students’ lives and is the primary conduit for accessing the internet. Objective research into the promise and dangers of this device is critical. While educational uses of the smartphone with young adults hold promise, the potential for harm is also present. While objectivity is valued, the focus of researchers can subjectively skew towards optimistic or pessimistic views of technology. The topics addressed in smartphone and learning research illuminate trends and potential biases in the field. This study investigates the issues addressed in smartphone and learning research in the past two years. These topics are compared with smartphone research in a similar field: psychology. The study, using a bibliometric approach, identified an overall negative arc of the literature towards topics such as addiction, depression, and anxiety in the psychology literature. The educational literature topics were comparatively more positive than psychology. Highly cited papers in both fields reflected explorations of adverse outcomes.

Abstract: Malnutrition in all its forms has risen on global agendas due to the recognition of its magnitude and consequences for a wide range of human, social, and economic outcomes. Implementing strategies and programs with the needed scale and quality is a major challenge. The Brazilian National Survey on Child Nutrition (ENANI-2019) pointed out several advances but numerous challenges. In this paper, we reflect on the implementation progress of breastfeeding, complementary feeding and young children malnutrition strategies and programs in Brazil and how existing challenges can be overcome through the lens of implementation science. First, we present a brief history of such programs. Second, we selected two breastfeeding initiatives to illustrate and reflect on common implementation challenges. In these case studies, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to analyze the implementation and scaling up barriers and facilitators. We found common barriers related to unclear goals about the reach of programs, challenges in assessing effectiveness and fidelity/quality during the real-world implementation, discontinuation or lack of funding, and lack of monitoring and evaluation impacting the sustainability of programs. We also discuss the use of implementation science to achieve adequate nutrition by 2030 and present critical elements for successful scale implementation of nutrition programs based on global evidence. Despite the investment to implement different actions aimed at facing infant feeding and malnutrition, high-quality implementation research must become a priority to catalyze progress in Brazil.