Immersive Leadership Training for Physicians: Comparing Retrospective Pre- and Post-Test Virtual vs in-Person 6-Month Follow-Up of Learning.

Purpose: Little is known about the long-term efficacy of virtual leadership training for physicians. This study compares two highly similar groups of Obstetricians-Gynecologists' (OB-GYN) 6-month post-program changes in competency and skills after experiencing equity-centered leadership training in a virtual or in-person format. Participants and Methods: Using a retrospective pre- and post-test method, we collected 6-month post-program data on 14 competencies for knowledge gains and skills use, comparing the virtual cohort (2021, n = 22) to the in-person cohort (2022, n = 33) in 55 total participants. Qualitative data from open-ended feedback questions informed on skills relevancy and professional impact since program participation. Results: Data indicate strong, statistically significant knowledge and skills retention in both cohorts, with 63% of the virtual and 85% of the in-person participants responding. Data indicate participants report the course having a positive impact on their healthcare provision and nearly all report they made changes to their communication and leadership approaches in the 6-months after the program. 59% of the virtual and 55% of the in-person cohorts report new leadership opportunities since their participation and that the course helped prepare them for those roles. Qualitative data support the need for the training, specific elements of the training these physicians found particularly helpful, and that the learning was "sticky", in that it stayed with them in the months post-program. There was a clear stated preference for in-person experiences. Conclusion: Either virtual or in-person leadership training can result in long-term (6-month) significant retention and application of knowledge and skills in physicians. While limited in size, this study suggests that in-person experiences seem to foster more effective bonds and also greater willingness to participate in post-program follow-up. Physicians find equity-centered leadership training to impact their subsequent communication and leadership practices and they report career benefits even in 6-month follow-up.

While physicians serve in many leadership roles in healthcare, leadership training is generally not part of their medical training. The American College of Obstetricians and Gynecologists (ACOG) Robert C. Cefalo Leadership Institute has provided an annual leadership training for obstetrician and gynecologist leaders since 2006. Our previous research has repeatedly shown the program is effective, with participants experiencing significant and impressive gains in leadership learning and skills development. The COVID-19 pandemic led to the 2021 program being held virtually with a return to an in-person format possible with the 2022 program. As such, the opportunity arose to compare the 6-month post-program learning and impact of these two formats, virtual versus in-person training, in two highly similar groups experiencing nearly identical program content. Both virtual and in-person participants rated their six-month post-program skill level/ability and skills use/implementation as significantly higher than pre-program and both groups noted the learning helped them be better physicians, communicators, and leaders. Additionally, many experienced new leadership opportunities in the 6-months post-program and most of those agreed that the program prepared them to take on those new roles. This study shows that our approach to physician leadership development is highly effective and that the learning demonstrated "stickiness" in that it persisted over time. While both virtual and in-person programs were highly effective, overwhelmingly the participants prefer in-person training to virtual training.

Cognitively healthy APOE4/4 carriers show white matter impairment associated with serum NfL and amyloid-PET.

Except for aging, carrying the APOE ε4 allele (APOE4) is the most important risk factor for sporadic Alzheimer's disease. APOE4 carriers may have reduced capacity to recycle lipids, resulting in white matter microstructural abnormalities. In this study, we evaluated whether white matter impairment measured by diffusion tensor imaging (DTI) differs between healthy individuals with a different number of APOE4 alleles, and whether white matter impairment associates with brain beta-amyloid (Aß) load and serum levels of neurofilament light chain (NfL). We studied 96 participants (APOE3/3, N = 37; APOE3/4, N = 39; APOE4/4, N = 20; mean age 70.7 (SD 5.22) years, 63% females) with a brain MRI including a DTI sequence (N = 96), Aß-PET (N = 89) and a venous blood sample for the serum NfL concentration measurement (N = 88). Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AxD) in six a priori-selected white matter regions-of-interest (ROIs) were compared between the groups using ANCOVA, with sex and age as covariates. A voxel-weighted average of FA, MD, RD and AxD was calculated for each subject, and correlations with Aß-PET and NfL levels were evaluated. APOE4/4 carriers exhibited a higher MD and a higher RD in the body of corpus callosum than APOE3/4 (p = 0.0053 and p = 0.0049, respectively) and APOE3/3 (p = 0.026 and p = 0.042). APOE4/4 carriers had a higher AxD than APOE3/4 (p = 0.012) and APOE3/3 (p = 0.040) in the right cingulum adjacent to cingulate cortex. In the total sample, composite MD, RD and AxD positively correlated with the cortical Aß load (r = 0.26 to 0.33, p < 0.013 for all) and with serum NfL concentrations (r = 0.31 to 0.36, p < 0.0028 for all). In conclusion, increased local diffusivity was detected in cognitively unimpaired APOE4/4 homozygotes compared to APOE3/4 and APOE3/3 carriers, and increased diffusivity correlated with biomarkers of Alzheimer's disease and neurodegeneration. White matter impairment seems to be an early phenomenon in the Alzheimer's disease pathologic process in APOE4/4 homozygotes.

Factors Associated with Obstetric Violence Implicated in the Development of Postpartum Depression and Post-Traumatic Stress Disorder: A Systematic Review.

Postpartum depression (PPD) and post-traumatic stress disorder (PTSD) continue to be prevalent, and disabling women with mental disorders and obstetric violence (OV) may be a trigger for them, particularly during maternity. We aimed to analyze the association between manifestations of OV with the development of PPD and PTSD during pregnancy, childbirth, and postpartum. This systematic review was based on the PRISMA 2020 statement and explored original articles published between 2012 and 2022. A total of 21 articles were included in the analysis, and bias was assessed by the Effective Public Health Practice Project's Quality Assessment Tool. The highest rate of PPD symptoms appeared in women under 20 years old, multiparous, and with low education levels. The higher PTSD ratio was present in women under 35 years, primiparous, and with secondary studies. The mode of labor (instrumental or C-section) was identified as a major risk factor of PPD, being mediator variables of the informal coercion of health professionals and dissatisfaction with newborn healthcare. Instead, partner support during labor and high satisfaction with healthcare during birth were protective factors. Regarding PTSD, the mode of labor, several perineal tears, and the Kristeller technique were risk factors, and loss of autonomy and coercion modulated PTSD symptomatology. The protective factors for PTSD were respect for the labor plan, adequate communication with health professionals, social support during labor, and the skin-to-skin procedure. This systematic review provides evidence that OV contributes to PPD and PTSD, being important in developing standardized tools to prevent it. This study recommends changes in maternal healthcare policies, such as individualized healthcare assistance, humanized pregnancy protocols, and women's mental health follow-up, and improvements in the methodological quality of future research.

Ongoing declines for the world's amphibians in the face of emerging threats.

Systematic assessments of species extinction risk at regular intervals are necessary for informing conservation action1,2. Ongoing developments in taxonomy, threatening processes and research further underscore the need for reassessment3,4. Here we report the findings of the second Global Amphibian Assessment, evaluating 8,011 species for the International Union for Conservation of Nature Red List of Threatened Species. We find that amphibians are the most threatened vertebrate class (40.7% of species are globally threatened). The updated Red List Index shows that the status of amphibians is deteriorating globally, particularly for salamanders and in the Neotropics. Disease and habitat loss drove 91% of status deteriorations between 1980 and 2004. Ongoing and projected climate change effects are now of increasing concern, driving 39% of status deteriorations since 2004, followed by habitat loss (37%). Although signs of species recoveries incentivize immediate conservation action, scaled-up investment is urgently needed to reverse the current trends.

At-sea distribution patterns of the Peruvian diving petrel Pelecanoides garnotii during breeding and non-breeding seasons.

At-sea distributions of seabird species are strongly associated with the distribution patterns of their prey, which are influenced by physical oceanic features. During breeding and non-breeding seasons, seabirds move extraordinary distances among different environments. However, foraging site fidelity by seabirds appears to be high in areas of known high productivity, such as frontal zones and upwellings. Here, we present a tracking study for the Peruvian diving-petrel Pelecanoides garnotii, an endemic seabird of the highly productive Humboldt Current System, to assess whether adults use the same foraging areas throughout the year, combining data from nest monitoring and global location sensors (GLS) deployed on 12 individuals between two breeding seasons (2013-2014 and 2014-2015), in Choros Island (29°15'S; 71°32'W), Chile. Two main foraging areas were registered. During the breeding season, adults moved in the northern direction, between 60 to 144 km away from their colony, foraging in areas with high primary productivity. During the non-breeding period, they moved to southern latitudes (~ 1200 km). Adults spent 37% and 63% of their time in flight/land and on/underwater activities, respectively. We determined that birds move northward from their colony during breeding, where prey availability seems more predictable throughout the year. However, during the non-breeding period, it is likely that other environmental factors influence the distribution pattern of the Peruvian diving-petrel.

Evaluating Leadership Development Competencies of Clinicians to Build Health Equity in America.

INTRODUCTION: To achieve more equitable health, health care must be grounded in an understanding of social determinants of health. Clinicians need hands-on, equity-centered training in interdisciplinary settings where they can further develop leadership skills and apply learnings in real-time. The Clinical Scholars program trained five cohorts of health care professionals in 25 leadership development competencies to contribute toward advancing health equity within the organizations and communities where they work. This study describes the self-reported ratings of three dimensions of competencies within four domains. METHODS: Data from 169 Fellows were collected at three time-points during the three-year training program using Qualtrics and Research Electronic Data Captrue software. Analysis was conducted in R and included descriptive statistics, fitting a linear mixed-effects model using random intercepts, and paired-sample t tests to assess significance between baseline and endpoint ratings. RESULTS: We found improved ratings over time for each of the three competency dimensions (knowledge, self-efficacy, use) and significant differences in ratings from baseline to endpoint, by domain (personal, interpersonal, organizational, community, and systems). DISCUSSION: These findings support the effectiveness of an equity-centered leadership development curriculum in training health care professionals to address health challenges in their communities and organizations, thereby furthering the broader goal of achieving more equitable health for all.

Comparing Virtual vs In-Person Immersive Leadership Training for Physicians.

Purpose: The COVID-19 pandemic caused a disruption of in-person workforce development programs. Our immersive physician-oriented leadership institute suspended in 2020, resumed in 2021 with a virtual program, and in 2022 reconvened in-person training. We used this opportunity to compare the participant experience, including reported knowledge acquisition and ability gains, between these nearly identical curricula delivered in vastly different circumstances and formats. Participants and Methods: We describe the differences in immersive leadership training implementation and adaptations made for virtual vs in-person engagement of two cohorts of OB-GYN physicians. Data were collected from virtual (n=32) and in-person (n=39) participants via post-session surveys. Quantitative data reported includes participant ratings for knowledge gain and ability gain. Qualitative data were obtained via open-ended feedback questions per session and the overall experience. Results: Knowledge and ability scores indicated strong, statistically significant gains in both formats, with some reported learning gains higher in the virtual training. Qualitative data of participant feedback identified a number of positive themes similar across the in-person and virtual settings, with virtual participants noting how construction of the virtual program produced highly effective experiences and engagement. Constructive or negative feedback of the virtual setting included time constraint issues (eg, a desire for more sessions overall or more time per session) and technical difficulties. Positive comments focused on the effectiveness of the experience in both formats and the surprising ability to connect meaningfully with others, even in a virtual environment. However, there were also many comments clearly supporting the preference for in-person over virtual experiences. Conclusion: Immersive physician leadership training can be effectively delivered via virtual or in-person methods, resulting in significant reported gains of knowledge and skills. These programs provide valuable interpersonal connections and skills to support physician leadership. While both formats are effective, participants clearly prefer in-person leadership development experiences and interpersonal learning.

Factores de riesgo asociados a la agresividad en adolescentes: diferenciación por sexo

La agresividad se ha reconocido como prevalente en la población adolescente, debido a su carácter impulsivo y de inestabilidad emocional, que también caracteriza a la adolescencia. Ello lleva a la necesidad de conocer la frecuencia y la relación de los factores de riesgo de la agresividad en población adolescente, explorando sus diferencias según sexo. Así, esta investigación de enfoque cuantitativo, diseño no experimental, transversal de alcance correlacional, estudió la presencia y las relaciones entre la agresividad y sus factores de riesgo en 212 mujeres y 188 hombres adolescentes, entre 12 y 17 años de edad. Para lo cual, se aplicó una ficha de valoración de factores de riesgo y el cuestionario de agresividad premeditada e impulsiva (CAPI-A). Los hallazgos muestran mayor prevalencia de agresividad impulsiva, y la presencia de más relaciones con factores de riesgo en mujeres respecto a los hombres. Los factores de riesgos relevantes en las mujeres son las actitudes hacia la norma, la percepción sobre la agresividad y los sentimientos; en los hombres, las conductas de riesgo y los sentimientos. Esto resulta de utilidad para la comprensión de la agresividad como pauta comportamental, y el diseño de intervenciones preventivas de la agresividad y sus consecuencias.

The aggressiveness has been recognized as prevalent in teenage population due to their impulsive character, with that emotional instability which characterizes adolescence. This conducts to the need of knowing the frequency and the relationship of risk factors of aggressiveness in teenage population, exploring their differences according to sex. Thus, this research of quantitative approach, non-experimental design, cross-sectional of correlational scope, studied the presence and the relations between aggressiveness and its risk factors in 212 teenage women and 188 teenage men between 12 and 17 years of age. For this, a record card of risk factor evaluation was implemented along with the questionnaire of premediated / impulsive aggressiveness (CAPI-A in Spanish). The findings show a higher prevalence of impulsive aggressiveness and the presence of more relations to risk factors in women than in men. The relevant risk factors in women are the attitudes towards norms, the perception about aggressiveness and the feelings; in men, risk conducts and feelings are the ones to mention. These results useful for the comprehension of aggressiveness as a behavioral pattern, and the design of preventive interventions towards aggressiveness and their consequences.

Accelerating diversity, equity, and inclusion goals: a qualitative assessment from the lens of scientists at the 2020 Clinical Translational Science Awards Annual Meeting.

Participants in the leadership breakout session at the Clinical Translational Science Awards (CTSA) virtual 2020 conference discussed and ranked six recommendations in terms of feasibility, impact, and priority for advancing Diversity, Equity, and Inclusion (DEI) efforts to elevate underrepresented populations to leadership positions in CTSAs and their broader institutions. A thematic analysis of chat and polling data identified challenges and opportunities to achieve DEI goals, with the three most promising recommendations as: cross-institutional Principal Investigator (P.I.) action-learning workgroups, transparent policies for recruiting and promoting underrepresented minorities (URM) leadership, and a clear succession plan to nurture and elevate URM leaders. Suggestions are made to improve DEI in CTSA leadership and allow for greater representation in the translational science field.

Cosmovisión andina: principios éticos en aculturados, endoculturados y transculturalizados / Andean cosmovision: ethical principles in acculturated, endoculturated and transculturalized people / Cosmovisão andina: princípios éticos em povos aculturados, endoculturados e transculturalizados

Resumen Los cambios políticos sucedidos en Bolivia en los últimos 50 años llevaron a modificaciones en la participación de grupos subalternizados y en la apreciación ética de la vida. Este estudio pretende establecer las conductas bioéticas de la cosmovisión andina en aculturados, endoculturados y transculturizados en La Paz, Bolivia. Se trata de una investigación mixta, exploratoria, etnográfica, transversal, comparativa sincrónica, diacrónica y sistemática, en la cual se aplicó un cuestionario validado por expertos (alfa de Cronbach de 0,932) a 399 personas (5,3% aculturadas; 73,9%, endoculturadas y 20,8%, transculturalizadas). Los resultados contrastados por hermenéutica obtuvieron cinco categorías, de las cuales la categoría relacionalidad era independiente a la culturación (p=0,262); mientras que las categorías conciencia ecológica, complementariedad, reciprocidad, concepto de salud, modelo social y comunitario dependían entre sí (p=0,000). Se constató que los sujetos aculturados del área rural presentaban mayor conocimiento de la ética ancestral. Se recomienda la promoción de políticas educativas relacionadas a ética.

Abstract The political changes that have taken place in Bolivia in the last fifty years have led to modifications in the participation of subalternized groups and changes in the ethical appreciation of life. This study aims to establish the bioethical behaviors of the Andean cosmovision in acculturated, endoculturated and transculturated people in La Paz, Bolivia. It is a mixed, exploratory, ethnographic, cross-sectional, comparative, synchronic, diachronic and systematic research, in which a questionnaire validated by experts (Cronbach's alpha 0.932) was applied to 399 people (5.3% acculturated; 73.9%, endoculturated and 20.8%, transculturated). The results contrasted by hermeneutics obtained five categories, of which the category relationality was independent of acculturation (p=0.262); while the categories ecological awareness, complementarity, reciprocity, concept of health, social model and community depended on each other (p=0.000). It was found that the acculturated subjects from the rural area presented greater knowledge of ancestral ethics. The promotion of educational policies related to ethics is recommended.

Resumo As mudanças políticas que ocorreram na Bolívia nos últimos 50 anos levaram a mudanças na participação de grupos subalternizados e na apreciação ética da vida. Este estudo tem como objetivo estabelecer os comportamentos bioéticos da cosmovisão andina em pessoas aculturadas, endoculturadas e transculturadas em La Paz, Bolívia. Trata-se de uma pesquisa mista, exploratória, etnográfica, transversal, comparativa, sincrônica, diacrônica e sistemática, na qual um questionário validado por especialistas (alfa de Cronbach de 0,932) foi aplicado a 399 pessoas (5,3% aculturadas, 73,9% endoculturadas e 20,8% transculturadas). Os resultados contrastados pela hermenêutica produziram cinco categorias, das quais a categoria relacionalidade era independente da aculturação (p=0,262), enquanto as categorias consciência ecológica, complementaridade, reciprocidade, conceito de saúde, modelo social e comunidade dependiam umas das outras (p=0,000). Constatou-se que os indivíduos aculturados de áreas rurais tinham maior conhecimento da ética ancestral. Recomenda-se a promoção de políticas educacionais relacionadas à ética.

[Prevalence and factors associated with subjective cognitive complaints in Latin American health workers during the COVID-19 pandemic]. / Prevalencia y factores asociados con las quejas cognitivas subjetivas del personal sanitario latinoamericano durante la pandemia de COVID-19.

Background and objectives: An increase in emotional disturbances and complaints about cognitive performance has been observed in Latin American healthcare workers during the SARS-CoV-2 pandemic, which can affect attention capacity and increase the levels of stress and burnout of these professionals. The objective was to analyse subjective cognitive complaints (SCC) and associated factors in health personnel during the COVID-19 pandemic in five Latin American countries.Methods: Multicentre cross-sectional study, which included 3,738 professionals from Colombia, Chile, Argentina, Ecuador, Bolivia, and Peru. The Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9) was used to assess depression, and the Mini-Z to assess Burnout. For the SCC, an item on cognitive concerns in attention and memory was used.Results: The prevalence of cognitive complaints was 69.2%. The factors associated with a higher risk of SCC were the scores in the GAD-7, PHQ and Mini-Z, in addition to being part of the Ecuadorian health personnel.Conclusions: There is a high prevalence of SCC in health personnel, which is modulated by emotional states and stress.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults / Utilidade clínica do phototest via teleneuropsicologia em idosos rurais chilenos

ABSTRACT. The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

RESUMO. A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.

Leadership Development to Advance Health Equity: An Equity-Centered Leadership Framework.

Enduring questions about equity are front and center at this watershed moment in health care and public health. Inequities that became evident in the COVID-19 pandemic in 2020 have highlighted long-standing disparities in health by race and ethnicity. Current crises require examining and reorienting the systems that have, for decades, produced these health inequities; yet, public health and health care leaders are inadequately prepared to respond. The authors offer an equity-centered leadership framework to support the development of visionary leaders for tomorrow. This framework for leadership development programs interweaves traditional leadership and equity, diversity, and inclusion domains in both conceptual knowledge and skills-based teaching for health care and public health leaders, grouping competencies and skills into 4 domains: personal, interpersonal, organizational, and community and systems. A framework such as this will equip leaders with the mindset and skill set to challenge the paradigms that lead to inequity and health disparities.

Using a most significant change approach to evaluate learner-centric outcomes of clinical scholars leadership training program.

BACKGROUND: Most significant change (MSC) analysis is an evaluative method used to supplement outcome and impact program evaluations. MSC stories provide mini-narratives contextualizing the effect a program had on an individual. The Clinical Scholars program evaluation team used MSC to explore learner-centric leadership outcomes of the Clinical Scholars leadership training program. PURPOSE OF THE RESEARCH: To identify thematic outcomes of trainees during the three years of their leadership training in the Clinical Scholars program. RESULTS: We identified three central thematic areas of most significant change: (1) leadership in practice, (2) self-awareness, and (3) equity, diversity, and inclusion. Other present themes included stakeholder engagement, effective leadership, collaboration, impact, expanded influence, innovation, networking, community engagement, evidence-based, implementation science, organizational development, hope, and advocating within organizations, teams, and the community. A total of 25 mid- and advanced-career level participants represented a diverse array of disciplines within the healthcare sector. CONCLUSIONS: MSC stories represented leaders' individual and team growth due to participating in the Clinical Scholars program. Results confirmed fidelity of program implementation to the original program goals, as outlined in the grant proposal. They highlighted three critical areas of development for this cohort of Fellows.

Advancing Health Equity Through Equity-Centered Leadership Development with Interprofessional Healthcare Teams.

INTRODUCTION: Events of spring 2020-the COVID19 pandemic and re-birth of a social justice movement-have thrown disparities in disease risk, morbidity, and mortality in sharp relief. In response, healthcare organizations have shifted attentions and resources towards equity, diversity, and inclusion (EDI) issues and initiatives like never before. Focused, proven equity-centered skill and mindset development is needed for healthcare professionals to operationalize these pledges and stated aims. AIM: This article highlights program evaluation results for this Clinical Scholars National Leadership Institute (CSNLI) specific to EDI. We will show that CSNLI imparts the valuable and essential skills to health professionals that are needed to realize health equity through organizational and system change. SETTING: Initial cohort of 29 participants in CSNLI, engaging in the program over 3 years through in-person and distance-based learning offerings and activities. PROGRAM DESCRIPTION: The CSNLI is a 3-year, intensive leadership program that centers EDI skill development across personal, interpersonal, organizational, and systems domains through its design, competencies, and curriculum. PROGRAM EVALUATION: A robust evaluation following the Kirkpatrick Model offers analysis of four data collecting activities related to program participants' EDI learning, behavioral change, and results. DISCUSSION: Over the course of the program, participants made significant gains in competencies related to equity, diversity, and inclusion. Furthermore, participants demonstrated growth in behavior change and leadership activities in the areas of organizational and system change. Results demonstrate the need to center both leader and leadership development on equity, diversity, and inclusion curriculum to make real change in the US Healthcare System.

The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity.

INTRODUCTION: The impact of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) has not been widely quantified, and the data in the literature remain controversial. MATERIALS AND METHODS: Candidates for LSG underwent barium swallow, esophageal manometry, ambulatory 24-h esophageal pH monitoring (APM), and gastric emptying scintigraphy before and after surgery (1 and 18 months). Symptoms were evaluated using a gastroesophageal reflux disease questionnaire (GERDq). Esophagogastroduodenoscopy was performed preoperatively in all patients and at 18 months postoperatively in patients who had suffered from preoperative esophagitis. RESULTS: Fifty-two patients were included in the study (64.4% women and 34.6% men) with a median age of 46 years (25-63 years) and BMI of 45.0 ± 5.6 kg/m2. The follow-up rates at 1 and 18 months were 82.7% and 80.8%. At 18 months, the percentage of weight loss (%TWL) was 33.6 ± 10.4% and the percentage of excess BMI loss (%EBMIL) was 77.6 ± 25%. Postoperatively, a significant increase in accelerated gastric emptying and impaired esophageal body motility occurred at 1 and 18 months. A significant worsening of all the values obtained at both 1 and 18 months postoperatively becomes evident when comparing the results of the APM. After surgery, 76.4% of patients had developed "de novo" GERD at 1 month and 41% at 18 months. No improvement was found in patients with symptomatic GERD. CONCLUSION: Based on the results of this study, LSG led to a considerable rate of postoperative "de novo" GERD. In addition, no improvement was found in patients with symptomatic GERD.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults.

The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.

Caracterización de la conducta agresiva y de variables psicosociales en una muestra de adolescentes de la ciudad de Bucaramanga y su área metropolitana / Characterization of aggressive behaviour and psychosocial variables in a sample of adolescents from the city of Bucaramanga and its metropolitan área

Resumen Introducción: La agresividad es una variable que se ha venido asociando a problemas sociales y clínicos; a su vez, se ha estimado un incremento de la misma denotando un riesgo mayor en población infanto-juvenil. Objetivo: Describir las características de la conducta agresiva y variables psicosociales asociadas (tipo de relaciones familiares y antecedentes personales), en una muestra de 351 adolescentes ente 12 y 17 años de edad de la ciudad de Bucaramanga y su área metropolitana. Método: Es una investigación cuantitativa de alcance descriptivo transversal. Se empleó un Cuestionario "Ad hoc" y el Cuestionario de Agresividad Premeditada e Impulsiva en Adolescentes (Andreu, 2010), los cuales se aplicaron de forma autoadministrada desde un muestreo no probabilístico. Los resultados se obtuvieron a través del programa estadístico SPSS, realizando un análisis estadístico de medidas de tendencia central y Chi cuadrado. Resultados: Se identificó que la agresividad es frecuente en los adolescentes, especialmente de tipo impulsiva (33 %), y predominando en las mujeres (premeditada= 25,4 %; impulsiva= 37,3 %). Los adolescentes con agresividad impulsiva alta se caracterizaban por menor edad (12 años= 7,7 %) y menor nivel académico (séptimo grado o menos= 14,8 %). De forma genérica, quienes tenían agresividad alta, tenían relación distante desde lo afectivo y físico con el padre, y antecedentes de haber tenido problemas con otros por ejercer la agresión. Conclusión: Los hallazgos comprueban la frecuencia de la agresividad en la adolescencia, y llevan a reflexionar sobre posibles cambios en los roles sociales sobre la expresión de las emociones. Es fundamental estudiar la relación de la agresividad con la impulsividad, la edad, la dinámica relacional con los padres, con el fin de brindar mayores aportes en el desarrollo de estrategias de prevención de la conducta disfuncional asociada a la agresividad.

Abstract Introduction: Aggression is a variable that has been associated with social and clinical problems; at the same time, an increase in it has been estimated, denoting a higher risk in the child-adolescent population. Objective: To describe the characteristics of aggressive behavior and associated psychosocial variables (type of family relationships and personal history), in a sample of 351 adolescents between 12 and 17 years of age from the city of Bucaramanga and its metropolitan area. Method: It is a quantitative investigation of transversal descriptive scope. An "Ad hoc" Questionnaire and the Premeditated and Impulsive Aggression Questionnaire in Adolescents (Andreu, 2010) were used, which were self-administered from a non-probabilistic sampling. The results were obtained through the SPSS statistical program, performing a statistical analysis of measures of central tendency and Chi square. Results: It was identified that aggressiveness is frequent in adolescents, especially of the impulsive type (33 %), and predominantly in women (premeditated = 25,4 %; impulsive = 37,3 %). Adolescents with high impulsive aggressiveness were characterized by younger age (12 years = 7,7 %) and lower academic level (seventh grade or less = 14,8 %). In a generic way, those who had high aggressiveness, had a distant emotional and physical relationship with the father, and a history of having had problems with others for exerting aggression. Conclusion: The findings verify the frequency of aggressiveness in adolescence, and lead to reflect on possible changes in social roles on the expression of emotions. It is essential to study the relationship of aggressiveness with impulsivity, age, and relationship dynamics with parents, in order to provide greater contributions in the development of strategies for the prevention of dysfunctional behavior associated with aggressiveness

Prevalence of Dementia and Associated Factors among Older Adults in Latin America during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has had a great impact on cognitive health in Latin American older adults, increasing the risk of cognitive impairment and dementia. Our objective was to analyze the prevalence of dementia and the associated factors in Latin American older adults during SARS-CoV-2 pandemic. METHODS: A multicentric first phase cross-sectional observational study was conducted during the SARS-CoV-2 pandemic. Five thousand two hundred and forty-five Latin American adults over 60 years of age were studied in 10 countries: Argentina, Bolivia, Chile, Colombia, Ecuador, Guatemala, Mexico, Peru, the Dominican Republic, and Venezuela. We used the telephone version of Montreal Cognitive Assessment, the "Alzheimer Disease 8" scale for functional and cognitive changes, and the abbreviated version of the Yesavage depression scale. We also asked for sociodemographic and lockdown data. All the evaluation was made by telephone. Cross-tabulations and χ2 tests were used to determine the variability of the prevalence of impairment by sociodemographic characteristics and binary logistic regression to assess the association between dementia and sociodemographic factors. RESULTS: We observed that the prevalence of dementia in Latin America is 15.6%, varying depending on the country (Argentine = 7.83 and Bolivia = 28.5%). The variables most associated with dementia were race and age. It does not seem to be associated with the pandemic but with social and socio-health factors. CONCLUSION: The prevalence of dementia shows a significant increase in Latin America, attributable to a constellation of ethnic, demographic, and socioeconomic factors.