Alcohol consumption among adolescents is a social and public health issue. School-based programs are needed to prevent the onset of alcohol consumption during adolescence. Information and communication technologies offer new promising approaches to deliver preventive programs to these populations. The most traditional, successful programs use group dynamics within the classroom. However, the usefulness of social interaction features (SIF) within internet-based interventions remains unclear. The current scoping review aims to identify and evaluate the effectiveness of online and mobile psychosocial preventive interventions that use SIF, and that target adolescents. Web of Science, Scopus and Google Scholar were electronically searched for all articles published between January 2011 and December 2020. Articles reporting on school-based, web-based interventions for adolescents to prevent alcohol consumption and that encouraged any kind of interaction between users ('social interactions') were eligible for inclusion. Fourteen articles were included in the review. These articles assessed eight preventive programs. Six programs showed positive results on outcome variables. In two of them, it was possible to determine that their success was partially due to the SIF. SIF seem to be useful to enhance the receptivity and usefulness of web-based prevention programs, but the current evidence of their effectiveness is scarce. More evidence is required to assess the effectiveness of these features and to improve programs having the objective of preventing the consumption of alcohol among young people.

La ética del cuidado es la propuesta de Carol Gilligan, tras notar el sesgo de género que contenía la tabla del desarrollo moral, propuesta por Lawrence Kohlberg. Gilligan plantea que, mientras el varón tiende a resolver los dilemas morales de manera racionalista, apelando a la idea de justicia, la mujer utiliza también el apego y la empatía. Entonces, propone agregar, en el juicio moral, todo aquello que la mujer capta mejor para corregir el sesgo del sistema de Kohlberg. Por su parte, Nel Noddings convierte la ética del cuidado en una propuesta pedagógica, en diálogo con el movimiento de la educación del carácter. Su modelo contempla cuatro componentes básicos: modelamiento, diálogo, práctica y confirmación. Noddings indica que superar el sesgo de género implica que el juicio moral no se reduzca a la racionalidad instrumental, pero propone evitar caer en el emotivismo. De allí que su propuesta apele a una correcta educación del corazón, buscando un equilibrio entre corazón y cabeza. En este sentido, ambas pensadoras lanzan un desafío positivo a las corrientes actuales de la educación del carácter, justo en un momento en que este campo educativo está expandiendo sus reflexiones fundamentales, mientras busca reflejar todos los aspectos de la persona humana.

Differentiation of self represents the integration of two life forces: autonomy and connection with others. The aims of this study were to test whether differentiation was associated with emotional connectedness in a sample of Panamanian emerging adults (n = 110) and to explore the psychometric properties of two instruments for use in the Panamanian cultural-context: the Spanish-Differentiation of Self Inventory (SDSI-R) and the Relational Health Indices - Spanish (RHI-S). Emotional cutoff showed a significant association with emotional connectedness while results showed no evidence of a relationship between emotional reactivity and emotional connectedness. Both questionnaires demonstrated reliability and validity. Implications for family therapy are discussed.

Bowen Family Systems Theory's central construct, differentiation of self (DoS), is one of the most recognized constructs to systemic researchers and psychology professionals. The present study reviewed the available evidence on DoS from the inception of the construct until July 31, 2020. A scoping review was conducted and a total of 295 primary studies were eligible for inclusion. Literature was categorized according to the hypotheses postulated by Bowen regarding: the associations between DoS and psychological and health outcomes and how DoS stability and similarity in partner levels operate within family systems. Descriptive data regarding studies on the measurement of DoS and in the area of psychotherapy were also compiled. Results revealed that there sample support for DoS as a predictor of psychological health and marital quality, and that there are positive associations between DoS and better physical health and intergenerational relationships. Results of this review show that there continue to be underexplored hypotheses and a paucity of longitudinal or causal research designs to test the stability of DoS, the intergenerational transmission of DoS, and the efficacy of clinical interventions in modifying DoS to promote optimal well-being. Recommendations and next steps for researchers and practitioners are outlined.

Introduction: Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries.Methods: PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries.Results: The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal).Conclusions: Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.

Anonymous questionnaires are frequently used in research with adolescents in order to obtain sincere answers about sensitive topics. Most longitudinal studies include self-generated identification codes (SGICs) to match information. Typical elements include a combination of letters and digits from personal data. However, these data may make the participant feel that their answers are not truly anonymous, and some studies using these types of SGICs have been perceived as not entirely anonymous by some participants. Furthermore, data protection laws could place limits on research carried out with these codes. The objective of our article is to test an SGIC with a higher degree of anonymity. We conducted two studies. In Study 1, we tested the perceived anonymity of this new SGIC code. Adolescents aged 12 to 18 years (N = 601) completed an anonymous questionnaire about lifestyles and risk behaviors, which also included the SGIC. Adolescents with and without risk behaviors were compared regarding whether or not they answered to the SGIC questions. We did not find any differences to suggest that participants felt identifiable. In Study 2, we assessed the efficiency of the new SGIC. At baseline, 123 students from two high schools (eighth grade) filled in questionnaires consisting of the new SGIC and their full names. Two years later, these same students (then in the 10th grade) were invited to fill in the same information again (116 students responded to this second call). A total of 97 students were present in both waves. The SGIC showed a moderate performance, with good enough indices of recall and precision. Evidence suggests that the new SGIC is a suitable tool for the anonymous matching of adolescents in follow-ups of school cohorts.

Aims To determine the associations between internal assets (planning and decision-making, interpersonal competence and commitment to learning) and substance use (tobacco, alcohol, binge drinking, marijuana use and other drugs). Design A cross-sectional study was conducted in four countries (Chile, Mexico, Spain and Peru). Methods Adolescents aged 12-18 self-completed a multi-purpose questionnaire between 2016 and 2019. Multiple logistic regressions and structural equation models were performed to analyse the association between internal assets (planning and decision-making, interpersonal competence, and commitment to learning) and substance use. Results The results indicate that planning and decision-making and commitment to learning are conducive to the prevention of substance use. On the contrary, interpersonal competence was not associated with substance use. Conclusion The present study shows that planning and decision-making and commitment to learning can be relevant factors in explaining substance use during adolescence. Internal assets can be an important aspect to include in health promotion interventions with children, youth and families to prevent substance use. These findings may be useful for researchers, schools, paediatric nurse practitioners, and health professionals in general to design health programs focused on children and adolescents. Furthermore, the Developmental Assets framework has been proved as a suitable frame of reference for paediatric nurse practitioners to assess and develop child and adolescent positive development and design health promotion interventions to prevent substance use.

Human Papillomavirus (HPV) type 16 is the main etiological agent of cervical cancer worldwide. Mutations within the virus genome may lead to an increased risk of cancer development and decreased vaccine response, but there is a lack of information about strains circulating in Sub-Saharan Africa. Endocervical cytology samples were collected from 480 women attending a voluntary cervical cancer screening program at Monkole Hospital and four outpatient centers in Kinshasa, Democratic Republic of the Congo (DRC). The prevalence of HPV infection was 18.8% and the most prevalent high-risk types were HPV16 (12.2%) followed by HPV52 (8.8%) and HPV33/HPV35 (7.8% each). HPV16 strains were characterized: 57.1% were classified as C lineage; two samples (28.6%) as A1 and one sample belonged to B1 lineage. HPV33, HPV35, HPV16, and HPV58 were the most frequent types associated with low-grade intraepithelial lesion while high-grade squamous intraepithelial lesions were predominantly associated with HPV16. Several L1 mutations (T266A, S282P, T353P, and N181T) were common in Kinshasa, and their potential effect on vaccine-induced neutralization, especially the presence of S282P, should be further investigated. Long control region (LCR) variability was high with frequent mutations like G7193T, G7521A, and G145T that could promote malignancy of these HPV16 strains. This study provides a helpful basis for understanding HPV16 variants circulating in Kinshasa and the potential association between mutations of LCR region and malignancy and of L1 and vaccine activity.

This study tested an empirical model of the relationship between Personal Positive Youth Development (PPYD) and two contextual factors: Positive Parenting (PP), and Perception of the Climate and Functioning of the School (PcfS). The hypothesis tested was that a positive relationship with parents and a positive perception of the school will contribute to the prediction of PPYD. The sample was composed of 1507 adolescents recruited in 10 Spanish schools who were aged between 12 and 18 years and 52% were female. PPYD was evaluated through Dispositional optimism, Self-competence, and Sense of coherence. PP was evaluated through Affect and communication, Autonomy granting, Humor, and Self-disclosure. PcfS was evaluated through School climate, School bonds, Clarity of rules and values, and Empowerment. Previous reliability and validity analyses of the constructs were carried out, and correlational analyses and structural predictions were made. The results show that both PP and PcfS were associated with better scores in PPYD. Also, a positive correlation between those two contextual factors was found. Implications for applied research are discussed.

Scientific literature has shown contextual factors that predict youth development, and family variables are the most important ones. In this study, we propose a model that explains the relation between family variables (relationship with parents and family activities) and Personal Positive Youth Development (assessed through Life satisfaction, Interiority, and Self-control), across different cultures. We recruited 2867 adolescents aged 12-18 years (52% female) from three countries: Spain, Mexico, and Peru. They completed an anonymous questionnaire. We run exploratory and confirmatory factor analyses, and structural equation modelling, testing for invariance across countries and sexes. In all subsamples, positive family relationships were associated with adolescents' Life Satisfaction. In addition, time invested on family activities was associated with Interiority and with Self-control. However, some differences across cultures and sex were found in the specific associations. Theoretical and practical implications are discussed regarding how to improve adolescent development through family life.

Becoming a first-time father is an important transition period in men's lives that is frequently accompanied by joy and happiness. Engaging fathers has a broader impact on family and community and on fathers' own well-being. This study explores the process of men becoming first-time fathers and the experiences and challenges involved. Seventeen interviews with men in different stages of pregnancy, childbirth, and the postpartum period were conducted. Through a grounded theory design, a novel four-stage theoretical model emerged that represents the journey to first-time fatherhood. These stages are beginning the journey, fatherhood in limbo, facing reality, and settling down. Participants suggested that achieving a new normality was the final stage where they finally felt located with a sense of mastery in their journey to fatherhood. The novel theoretical approach of addressing the process of men's transition allowed more complete access to their perspectives. Men's needs are different at every phase of the transition to fatherhood, and the use of these findings can help care providers in caring for every man according to the stage he is facing.

Objectives: We examined the associations of lockdown stringency and duration with Google searches for four mental health concepts (i.e., Anxiety, Depression, Suicide, Mental Health) in nine countries (i.e., Hungary, India, Iran, Italy, Paraguay, Serbia, South Africa, Spain, Turkey) during the COVID-19 pandemic. Methods: We retrieved national-level data for each country from Google Trends and the Global Panel Database of Pandemic Policies. In our primary analysis, we used data from all countries to estimate a set of multilevel regression models examining associations of overall lockdown stringency and lockdown duration with relative search volumes for each mental health term. We repeated the models after replacing overall lockdown stringency with each of the lockdown stringency components. Results: A negative association was found between overall lockdown stringency and Depression. Lockdown duration and the most stringent stay-at-home requirements were negatively associated with Anxiety. Policies that recommended or required the cancelation of public events evidenced negative associations with Depression, whereas associations between policies that required some or all levels of schooling to close and Depression were positive. Policies that recommended or required workplaces to close and those that enforced quarantines on non-citizens arriving from high-risk regions or closed borders entirely were negatively associated with Suicide.

In the early stages of the COVID-19 pandemic, Italy, Spain, New York, and Hong Kong stood out for the ir high rates of infections. Given this scenario, a web-based international multisite and cross-sectional study was conducted between April and May 2020 to investigate the psychological impact of the pandemic and the restrictions imposed by the governments in these countries. We expected similar patterns in European countries, and no significant differences in terms of psychological impairment between Hong Kong (with a previous experience related to SARS, but subjected to restrictions for a longer time) and the other areas. Participants were 1955 adults from the above-mentioned areas. We assessed anxiety (GAD-7), depression (PHQ-9), COVID-19-related threats, and perceived burden of restrictive measures. Two-explorative factor analyses (EFAs) with Promax rotation identified COVID-19-related factors: personal physical threat, personal economic threat, global economic threat, and restriction-related burden. ANOVAs studied locations' differences and two-separate hierarchical multiple regression analyses by location determined whether and how COVID-19-related variables were associated with anxiety and depression, adjusting for age and sex. Italy and Hong Kong showed higher anxiety than Spain (p < 0.05); Hong Kong scored higher on depression than Italy and Spain (p < 0.001), which highlighted the lowest mean-score. New York participants showed the poorest mental health conditions. Anxiety was predicted by restriction-related burden (beta(NY) = 0.242; beta(HK) = 0.116) and personal economic threat (beta(NY) = 0.246; beta(HK) = 0.145) in New York (Adj.R-2 = 0.125) and Hong Kong (Adj.R-2 = 0.079); by global economic threat (beta = 0.199) and restriction-related burden (beta = 0.124) in Italy (Adj.R-2 = 0.108); and by personal physical threat (beta = 0.144) in Spain (Adj.R-2 = 0.049). Depression was predicted by restriction-related burden (beta(NY) = 0.313; beta(HK) = 0.120) and personal economic threat (beta(NY) = 0.229; beta(HK) = 0.204) in New York (Adj.R-2 = 0.161) and Hong Kong (Adj.R-2 = 0.089); by global economic threat (beta = 0.209) in Italy (Adj.R-2 = 0.149); and no predictors emerged in Spain. Findings could contribute to understanding the specific impact of the pandemic on people's psychological health in each area, along with the factors that impacted mental health. This information may be useful to implementing prevention interventions in case of restrictions.

Aim: To develop a taxonomy of activities in health prevention and promotion for primary care. Background: Despite health promotion being considered a keystone for population health and health care sustainability, its implementation remains insufficient. Customized evaluation tools are needed to address prevention and promotion omissions in primary care. Method: A taxonomy was designed using documentary analysis. Documents describing frontline primary care professionals' health prevention and promotion activities or omissions were identified and analysed using framework analysis. Results: The `Taxonomy of Activities in Health Prevention and Promotion for Primary Care¿ (TaxoPromo) includes 43 activities grouped into eight categories: planification, situational analysis, capacity building, development of awareness/public opinion, advocacy, development of networks, development of partnerships and intervention strategies. Conclusion: By contrasting the usual practices with the activities collected in the TaxoPromo, opportunities for improvement can be unveiled. Implications for Nursing Management: The TaxoPromo can be used at organisational and system levels to identify actions to integrate health prevention and promotion activities into a systematic, data-driven process; design implementation plans and tailor-made strategies for capacity building; enable benchmarking; and address omissions. The TaxoPromo can serve as a catalyst tool for the clarification and expansion of the nursing role in health prevention and promotion.

Background Couple relationship distress is common and associated with poor physical, psychological, and relational outcomes for both partners. Emotionally Focused Therapy for couples (EFT) is a short-term structured approach based on attachment theory that integrates a humanistic, experiential approach to restructuring emotional experience and a systemic structural approach to restructuring interactions. This model has been shown to be an effective treatment for couple distress. The supporting research, however, has only been conducted with English-speaking couples. Despite Spanish being the second-most spoken language and meaningful cultural differences between English- and Spanish-speaking countries, the efficacy of EFT has not been examined in this cultural context. This study will examine the efficacy of EFT in this particular context and advance the understanding of potential mechanisms of change. Methods We will use a multicenter randomized wait-list controlled design to examine the efficacy of EFT in a Spanish-speaking sample of moderately distressed couples. One hundred forty individuals in 70 couples in Argentina, Costa Rica, Guatemala, Mexico, and Spain will be randomly assigned to receive 19-21 sessions of EFT or be placed on a waitlist. Outcomes on a range of relational and individual mental health variables will be assessed prior to random assignment, throughout treatment, and at the conclusion of treatment. Primary outcomes will include dyadic adjustment, couple satisfaction, and attachment. Secondary variables, such as loneliness, parenting, affective communication, and sexual satisfaction, will be included as potential mediators of the treatment effect. Couples in the treatment group will also be assessed at 3-, 6-, 12-, 18-, and 24-month follow-ups. Process variables such as the therapeutic alliance will also be assessed routinely in couples assigned to the treatment group. Couples in the waitlist will receive a psycho-educational program based on EFT after completing the study. Discussion This study will be the first RCT of Emotionally Focused Therapy in a Spanish-speaking context. The results of the study will inform researchers interested in whether treatments developed and tested in the USA and Canada can be effective in differing cultural contexts. It may also point researchers and clinicians to areas where cultural adaptation is needed to improve efficacy.

Este estudio presenta la validación del Differentiation of self Inventory for Adolescents de Knauth y Skowron (2004). La diferenciación del self, un concepto utilizado por la teoría familiar sistémica de Bowen, se define como la capacidad de autorregulación emocional e intimidad con los demás. Un total de 1987 participantes de entre 14 y 21 años de edad participaron en el estudio. Los resultados del AFE (muestra 1; n=546) no confirman la estructura de cuatro factores del instrumento original. Dos subescalas aparecen más claramente reflejadas (Reactividad emocional, RE, y Corte emocional, CE) en las agrupaciones de ítems. Considerando estos resultados junto con la teoría que sustenta el constructo, se utilizó la muestra 2, en el que buscamos evaluar, a través de un Análisis Factorial Confirmatorio (AFC; n=1441), el ajuste de una propuesta del S-DSI para adolescentes españoles compuesta por 2 subescalas (RE y CE), con 10 ítems en cada una de ellas. Los resultados apoyaron esta solución, que es coherente con la propuesta de validación de esta misma escala en su versión para adultos españoles (Rodríguez-González et al., 2015). Se discuten las limitaciones, implicaciones teóricas y futuras investigaciones.

Oliva¿s Escala para la Evaluación del Estilo Parental (EEEP) [Scale for the evaluation of parenting styles] asks adolescents about their parents¿ education styles separately (¿your father¿ and ¿your mother¿) or in a combined way (¿your parents¿), but only the separated version has been tested for validity. The objective of this work was to carry out a validation of the combined version. A sample of 1507 adolescents, aged 12 to 18 years, was recruited. Exploratory and confirmatory factor analyses were run in two independent subsamples. Then, structural equation models (SEM) were run in order to test the association between the EEEP¿s subscales and adolescent outcomes (optimism, pessimism, and academic achievement). Results showed a good fit of the instruments¿ structure. Furthermore, the subscales showed associations with the outcomes. The EEEP can be reliably used in its combined form, which results in a reduction of items, often beneficial for research.

BACKGROUND: Cultural sensibility is an important concept linked to the achievement of cultural competence. Health professionals must first improve their cultural sensibility to become culturally competent and to be able to offer competent care to culturally diverse populations. Aim To develop and psychometrically test the Cultural Sensibility Scale for Nursing (CUSNUR), a cultural sensibility scale that can be used in nursing for the achievement of competencies needed to care for culturally diverse populations. DESIGN AND METHODS: The cross-sectional survey was conducted over two stages. The first stage involved the cross-cultural and discipline-specific adaptation of an existing scale addressing this concept in the field of law using the reverse translation method. Second, validation of the scale was carried out from October 2016-June 2017 by studying the psychometric properties of the questionnaire through an analysis of content acceptability and reliability and through exploratory factor analysis (EFA). RESULTS: The questionnaire was designed to be clear, easy to understand, and of adequate length, and experts involved in content validation agreed that the scale meets these criteria. A total of 253 nursing students participated in the validation stage. Four factors were identified from the EFA: (1) patient and health professional behaviours, (2) self-assessments, (3) self-awareness, and (4) cultural influence. Two items were excluded. Factorial saturation is adequate for all factors (>0.30). The Cronbach alpha was measured as 0.75. CONCLUSIONS: This study presents the first version of the CUSNUR and demonstrates that the scale is valid and reliable.

Background: Several instruments have been developed to assess adolescent dating violence but only few have been validated in Spanish-speaking settings. Some instruments are too long and may not be feasible to include them in a multipurpose questionnaire. We developed an instrument to be used in the YourLife project, an international project about young people lifestyles. Objective: We aimed to analyze the psychometric properties of this instrument in three Spanish-speaking countries (Chile, Ecuador, and Spain). Method: We included 1049 participants, aged 13-18 years. Exploratory and confirmatory factor analyses were conducted. Associations between dating violence and variables expected to covariate with it (substance use, school peer aggression, justification of dating violence, and relationship power imbalance), were tested. Results: Two different constructs (psychological and physical/sexual) for suffered and perpetrated violence were identified and confirmed in the three countries. The dating violence subscales had Cronbach's alpha scores higher than 0.85. The strongest associations between dating violence and variables related to it were found within the relationship power imbalance items, suggesting that these items may be useful to detect adolescent dating violence when a specific questionnaire cannot be implemented. Conclusion: This instrument seems to be adequate to assess suffered and perpetrated adolescent dating violence within a multipurpose questionnaire among schooled adolescents.

Introduction: Religiosity and sexuality present numerous interconnections. Little is known regarding the specific causal pathways between each religiosity dimension and sexual behavior. The objectives of this study were (1) to explore the relationship between religiosity (measured through attendance at religious services, salience, and prayer) and sexual initiation in adolescents and (2) to establish the role of sexual permissiveness as mediator of the impact produced by religiosity in sexual initiation.Methods: This study analyzes data from an ongoing school-based international study examining what young people feel and think about relationships, love, and sexuality. An anonymous, self-administered online questionnaire was developed in Spanish. A total of 4,366 students, aged 14-18, completed the questionnaire. A final sample of 2,919 questionnaires was analyzed. Two unconditional logistic regression models were fit with religiosity variables and possible confounders as independent variables (with and without permissiveness, respectively). The dependent variable was sexual initiation. A final path analysis was performed to further understand the results.Results: Our study highlights that, in predominantly Catholic and Spanish-speaking countries, the fact of attending church and praying may greatly contribute to postponing sexual relations during adolescence, even independently of their attitudes on sexual permissiveness. Conversely, the effect of salience on sexual initiation seems to be fostered only through the mediation of sexual permissiveness. Our findings point to an indirect effect of the three religiosity dimensions (and in particular, religious salience) through permissive attitudes.Conclusion: Religiosity could be a relevant factor to explain sexual initiation during adolescence.

Introduction: Currently, only 54% of the population of the Democratic Republic of the Congo (DRC) know their HIV status. The aim of this study was to detect HIV misdiagnosis from rapid diagnostic tests (RDT) and to evaluate serological immunoassays using dried blood spots (DBS) from patients in Kinshasa, DRC. Methods: Between 2016 and 2018, 365 DBS samples were collected from 363 individuals and shipped to Spain. The samples were from people with a new HIV positive ( n = 123) or indeterminate ( n = 23) result, known HIV-positive patients ( n = 157), and a negative control group ( n = 62). HIV serology was performed using Elecsys HIV combi PT (Roche), VIDAS HIV Duo Quick (BioMerieux), and Geenius (BioRad). In addition, HIV RNA detection was performed in all samples using the COBAS AmpliPrep/COBAS Taqman HIV-1 Test 2.0 (Roche). Results: Overall, 272 samples were found to be positive and 93 to be negative for HIV serology. The sensitivity was 100% for both Elecsys and VIDAS techniques, but specificity was slightly higher for the VIDAS test: 100% (96.1-100%) vs 98.9% (94.1-99.9%). Of the 23 indeterminate cases using RDT, only three cases were true-positives with a detectable viral load. Eleven samples out of the 280 classified as positive by RDT corresponded to nine patients who had received a false diagnosis of HIV through RDT (3.9%); six of them had been on antiretroviral therapy for at least 2 years. Conclusions: Elecsys HIV combi PT and VIDAS HIV Duo Quick immunoassays showed high sensitivity and specificity when using DBS. RDT-based serological diagnosis can lead to HIV misdiagnosis with personal and social consequences in sub-Saharan Africa. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Background Breastfeeding care plays a fundamental role in establishing breastfeeding and longer duration after discharge. Practices though vary among professionals involved and are often inconsistent with good practices recommended, being a threat to women's breastfeeding self-efficacy. Breastfeeding self-efficacy is considered a predictor for successful breastfeeding and a significant variable amenable to intervention for promoting lactation Aim To evaluate the efficacy, feasibility and acceptability of a new breastfeeding self-efficacy promoting programme (SIALAC) on 6-month breastfeeding maintenance. Methods In this exploratory multi-centre controlled trial, participants were allocated into control and intervention groups sequentially. Professionals in charge of the treatment groups were trained in between, with an especial focus on reducing practice variability. Control and intervention group women received usual care, and the intervention group received in addition SIALAC, a three-stage breastfeeding self-efficacy promoting programme. Primary outcome was breastfeeding maintenance up to 6 months analysed by Kaplan-Meier and Cox proportional hazard regression analysis. Student's t-test or chi-square tests were also used for continuous and categorical variables. Data on breastfeeding status and breastfeeding self-efficacy were collected at baseline, and 4, 8 and 24 weeks after birth. Results From May 2014 through November 2015, participants were enrolled. The sample consisted of 112 women. No relevant socio-demographic or obstetric difference was found between groups. The intervention achieved a significant difference between groups in breastfeeding survival (X-2 = 4.94, p = 0.026). Six-month breastfeeding maintenance was significantly higher in the intervention group (67% vs. 55%; X-2 = 5.384, p = 0.020). Breastfeeding dropout in the control group was 3.3 (CI 1.1, 10.1) times higher than that of the intervention group at 6 months. Breastfeeding self-efficacy scores were higher in the intervention group although without significant statistical difference. The programme showed good acceptability. Conclusion Breastfeeding self-efficacy promoting programme SIALAC was beneficial in fostering 6-month breastfeeding survival. Full-scale trial should consider feasibility-related issues identified.

Retention is a key element in HIV prevention programs. In Sub-Saharan Africa most data on retention come from HIV clinical trials or people living with HIV attending HIV treatment and control programs. Data from observational cohorts are less frequent. Retention at 6-/12-month follow-up and its predictors were analyzed in OKAPI prospective cohort. From April 2016 to April 2018, 797 participants aged 15-59 years attending HIV Voluntary Counseling and Testing in Kinshasa were interviewed about HIV-related knowledge and behaviors at baseline and at 6- and 12-month follow-ups. Retention rates were 57% and 27% at 6- and 12-month follow up; 22% of participants attended both visits. Retention at 6-month was significantly associated with 12-month retention. Retention was associated with low economic status, being studying, daily/weekly Internet access, previous HIV tests and aiming to share HIV test with partner. Contrarily, perceiving a good health, living far from antiretroviral center, daily/weekly alcohol consumption and perceiving frequent HIV information were inversely associated with retention. In conclusion, a high attrition was found among people attending HIV testing participating in a prospective cohort in Kinshasa. Considering the low retention rates and the predictors found in this study, more HIV cohort studies in Kinshasa need to be evaluated to identify local factors and strategies that could improve retention if needed.

This study assessed the cross-cultural relevance of Bowen Family Systems Theory by adapting and validating the Differentiation of Self Inventory - Revised in a sample of Greek Cypriots (N = 717). Results indicated high internal consistency (alpha = .90). Confirmatory factor analysis revealed an adequate fit of data to the original four-factor structure. Construct validity was demonstrated by a significant association between the Greek Differentiation of Self Inventory and trait-anxiety. Findings suggest the Greek Differentiation of Self Inventory - Revised is a valid and culturally sensitive instrument. Implications for counseling and therapy are discussed.

Background The inadequacy of HIV viraemia and resistance monitoring in Africa leads to uncontrolled circulation of HIV strains with drug resistance mutations (DRM), compromising antiretroviral therapy (ART) effectiveness. This study describes the DRM prevalence and its therapeutic impact in HIV-infected pediatric patients from Kinshasa (Democratic Republic of Congo, DRC). Methods From 2016-2018, dried blood were collected from 71 HIV-infected children and adolescents under ART in two hospitals in Kinshasa for HIV-1 DRM pol analysis, predicted ARV-susceptibility by Stanford and phylogenetic characterization. Results HIV-1 sequences were recovered from 55 children/adolescents with 14 years of median-age. All had received nucleoside and non-nucleoside reverse transcriptase inhibitors (NRTI, NNRTI), 9.1% protease inhibitors (PI) and only one integrase inhibitor (INI). Despite the use of ART, 89.1% showed virological failure and 67.3% carried viruses with major-DRM to one (12.7%), two (47.3%), or three (5.5%) ARV-families. Most children/adolescents harbored DRM to NNRTI (73.5%) or NRTI (61.2%). Major-DRM to PI was present in 8.3% and minor-DRM to INI in 15%. Dual-class-NRTI+NNRTI resistance appeared in 53.1% of patients. Viruses presented high/intermediate resistance to nevirapine (72.9% patients), efavirenz (70.9%), emtricitabine/lamivudine (47.9%), rilpivirine (41.7%), etravirine (39.6%), doravidine (33.3%), zidovudine (22.9%), among others. Most participants were susceptible to INI and PI. Great diversity of variants was found, with a high rate (40%) of unique recombinants. Conclusion The high DRM prevalence observed among HIV-infected children and adolescents in Kinshasa could compromise the 95-95-95-UNAIDS targets in the DRC. It also reinforces the need for routine resistance monitoring for optimal rescue therapy election in this vulnerable population to control the spread of resistant HIV in the country.

Positive family functioning during adolescence is usually studied analyzing parents¿ competences and children¿s relationship abilities. We present an instrument for the assessment of parental competence, which encompasses both educational style and transmission of values. The objective of the study was to analyze its factor structure and to assess its value in predicting adolescent outcomes. We recruited 2,459 high school students, aged 12-15, in 40 schools from Spain, Peru, Mexico, and Chile. They responded to the instrument and to other questions regarding lifestyles. Exploratory and confirmatory factor analyses were carried out in order to assess the internal structure of the instrument, and internal consistency of the resulting dimensions was calculated. Finally, regression analyses were performed to establish associations between the parenting dimensions and adolescent outcomes. Factor analyses showed a consistent structure, with good fit indices in the four countries. The final four factors include parenting styles (Warmth and Demandingness) and education in values (Fortitude and Privacy). Regression analyses showed associations with adolescent outcomes. For example, adolescents¿ life satisfaction was best predicted by Warmth and Education in fortitude. Practical implications are suggested.

Bowen and colleagues argued through their clinical observations that psychological distress is a result of low levels of differentiation of self. Starting from these premises, the main objective of the present investigation was to compare a normative sample and a sample of adults seeking services at a systemic therapy clinic. Initially, we assessed differences between groups in dimensions related to differentiation of self and psychological distress. In the second step, we examined whether differentiation of self dimensions would increase or reduce the likelihood that an individual belonged to either of the two groups. The help-seeking sample was comprised of 64 adults seeking therapeutic services, and the normative sample was comprised of 85 students. All participants completed the Differentiation of Self Inventory and the Symptom Checklist-90-Revised. We found that the participants of the help-seeking sample had significantly higher scores on the Global Severity Index and in I-position and emotional cutoff dimensions. We also found that higher emotional cutoff was the strongest predictor of the probability of belonging to the help-seeking group in the hypothesized model. These data suggest that information about differentiation of self might enable counseling psychologists and therapist to define effective interventions.

Arguably, the medical model's narrative achieved an iconic mental health status eulogized within our evidence¿based era. Despite Diagnostic and Statistical Manual of Mental Disorders' atheoretical pretensions, we attempt to shed light and critically challenge its dogmatic mental health presumptions through a family systems perspective. Specifically, our critical study of a fictitious vignette attempts to expose how the medical model's systematic de¿emphasis of familial environments directs clinicians away from the true source of triangulated children's distress, an attention shift that may result in unintentionally perpetuating children's psychological turmoil. Alternatively, we attempt to delineate how the system paradigm may holistically account for children's familial emotional environments, thereby potentially attributing their psychological distress to its true, yet concealed, familial dysfunction. In essence, we argue that the medical model seems to operate within a decontextualized restricted disease¿carrier¿child mind frame, hence potentially ascribing faux diagnoses and false medical treatments to healthy children.

Background and Purpose: Both adherence to the Mediterranean diet (MedDiet) and the use of metformin could benefit the cognitive performance of individuals with type 2 diabetes, but evidence is still controversial. We examined the association between metformin use and cognition in older adults with type 2 diabetes following a MedDiet intervention.</p> Methods: Prospective cohort study framed in the PREDIMED-Plus-Cognition sub-study. The PREDIMED-Plus clinical trial aims to compare the cardiovascular effect of two MedDiet interventions, with and without energy restriction, in individuals with overweight/obesity and metabolic syndrome. The present sub-study included 487 cognitively normal subjects (50.5% women, mean +/- SD age of 65.2 +/- 4.7 years), 30.4% of them (N = 148) with type 2 diabetes. A comprehensive battery of neurocognitive tests was administered at baseline and after 1 and 3 years. Individuals with type 2 diabetes that exhibited a good glycemic control trajectory, either using or not using metformin, were compared to one another and to individuals without diabetes using mixed-effects models with inverse probability of treatment weights.</p> Results: Most subjects with type 2 diabetes (83.1%) presented a good and stable glycemic control trajectory. Before engaging in the MedDiet intervention, subjects using metformin scored higher in executive functions (Cohen's d = 0.51), memory (Cohen's d = 0.38) and global cognition (Cohen's d = 0.48) than those not using metformin. However, these differences were not sustained during the 3 years of follow-up, as individuals not using metformin experienced greater improvements in memory (beta = 0.38 vs. beta = 0.10, P = 0.036), executive functions (beta = 0.36 vs. beta = 0.02, P = 0.005) and global cognition (beta = 0.29 vs. beta = -0.02, P = 0.001) that combined with a higher MedDiet adherence (12.6 vs. 11.5 points, P = 0.031). Finally, subjects without diabetes presented greater improvements in memory than subjects with diabetes irrespective of their exposure to metformin (beta = 0.55 vs. beta = 0.10, P < 0.001). However, subjects with diabetes not using metformin, compared to subjects without diabetes, presented greater improvements in executive functions (beta = 0.33 vs. beta = 0.08, P = 0.032) and displayed a higher MedDiet adherence (12.6 points vs. 11.6 points, P = 0.046).</p> Conclusions: Although both metformin and MedDiet interventions are good candidates for future cognitive decline preventive studies, a higher adherence to the MedDiet could even outweigh the potential neuroprotective effects of metformin in subjects with diabetes.

The increased interest on measuring violence in romantic relationships has led to the identification of some risk factors for intimate partner violence (IPV) in its different forms. Some of them are often present from the onset of the relationships. However, little attention has been paid to the engagement period. This might be, in part, due to the cognitive dissonance that hinders partners reporting intimate violence when they are planning their wedding. The purpose of our study is to test the association between the individual perception of relationship power imbalance (RPI)¿a possible indirect measure of intimate violence¿and known predictors of IPV. To test this hypothesis, a total of 254 premarital couples taking part in a dynamic prospective cohort study completed a questionnaire with questions about the perception of RPI and referred predictors of IPV. Results showed a positive correlation between the perception of RPI and known predictors of IPV. These findings suggest that RPI is a powerful indirect measure to detect situations that might imply a mild form of IPV and that could evolve into stronger presentations of violence later in marriage. Noticing the presence of RPI before marriage could encourage the prevention and development of personal and relational strategies to avoid the consolidation of violent dynamics within the marital relationship.

The main objective of this study was to analyze the relationship between structured, unstructured, and family leisure activities on the frequency of adolescent alcohol intake across three different countries (Spain, Peru, and The Netherlands). The self-control of adolescents was also investigated as a moderator in the relationship between leisure activities and alcohol consumption. Methodology: This research involved 4608 adolescents aged between 12 and 17 from three countries (Spain, Peru, and The Netherlands). In Spain and Peru, data was collected through a self-report questionnaire which was part of the Your Life project. In The Netherlands, a self-questionnaire was used, collected by the University of Utrecht. A multiple logistic regression was performed for each country. Results: The results showed that participation in unstructured leisure activities increased the likelihood of drinking more frequently and more heavily in all three countries. Structured leisure activities, in general, did not have a significant predictive effect on alcohol consumption in any of the countries. Family leisure activities reduced the risk of engaging in yearly alcohol use and yearly binge drinking among adolescents, especially in The Netherlands and Spain. The protective effect of family leisure and unstructured leisure risk on yearly alcohol use applied especially to Dutch adolescents with a low level of self-control. Discussion: The article emphasizes the need for parents to engage in leisure activities with their child; participation in unstructured activities is not to be encouraged.

A critical co-sleeping literature review revealed individualistic and dyadic guided approaches taken insofar, ridden by conflicting results. Thereby, we situated our approachbeyond the individual and dyad areawhere we developed anew a systemic co-sleeping paradigm, resulting in theoretical and preliminary empirical findings. Initial cross-gender analyses associated significantly co-sleeping with Bowen Family Systems Theory's cornerstone constructs. However, once the moderating effect of gender was examined, significancedisappeared across the board for females yet persisted for males.Specifically, male-children time-persistent co-sleeping was associated negatively withdifferentiationand positively withchronic anxietyand other hypothesized maladjustment effects (guilty feelings and abandonment feelings if moved away from parents). Effects drew attention to Bowen's systemic construct ofintergenerational emotional fusion.Guided by the empirical associations, we focused on gender development differences literature. We suggest thattriangulationprocesses dynamically embed co-sleeping within the family systems paradigm, with the embedment appearing to be significantly gendered.

Introducción: El objetivo principal de este estudio es analizar la relación entre el uso problemático de las tecnologías de la información y comunicación (UPT), las funciones ejecutivas (control inhibitorio, planificación y logro de metas) y las actividades de ocio de los/as adolescentes (ocio positivo y ocio no estructurado), en función del género, la edad y el rendimiento académico. Metodología: En esta investigación han participado 3.831 adolescentes escolarizados de 13 a 18 años de 4 países (Chile, España, México y Perú). El instrumento utilizado es el cuestionario de autoinforme del proyecto YOURLIFE. Se ha realizado un análisis de regresión lineal múltiple con el fin de obtener un modelo predictivo. Resultados Los análisis han mostrado que el UPT era más frecuente en el grupo de más edad. El modelo predictivo ha indicado que un menor control inhibitorio, así como las actividades de ocio no estructurado, se asociaban con el UPT. A su vez, las actividades de ocio positivo (actividades familiares y lectura recreativa) se han presentado como factores protectores de la UPT. Discusión: En el artículo se destaca la necesidad de desarrollar programas para adolescentes que promuevan actividades de ocio positivo, la intervención educativa y psicológica y la implicación de los padres y madres en la educación para el uso responsable y eficiente de las tecnologías de información y comunicación.

Background: Empathy is an essential competence in the medical field. There are no validated patient-rated empathy measures in Spanish (Spain). The Consultation and Relational Empathy (CARE) measure is a widely used patient-rated measure of physician empathy. Objective: To analyse the reliability and validity of the Spanish (Spain) version of the CARE measure in primary care. Methods: After translation, back translation and pilot testing, a convenient sample of 369 patients recruited through 21 primary care physicians in five primary care centres in Pamplona (Navarre, Spain) completed the Spanish (Spain) CARE (Sp-CARE) measure. The number of 'does not apply' or blank responses was calculated to assess acceptability. We analysed internal reliability by means of Cronbach's alpha and ordinal alpha and homogeneity with corrected item-total correlations.The construct validity was examined by confirmatory factor analysis (CFA) and concurrent validity by Spearman's correlation. Results: We observed high acceptability; only 37 (1%) responses were marked 'does not apply' and only 3 (0.08%) were left blank. Cronbach's alpha and ordinal alpha for the Sp-CARE measure were 0.953 and 0.970, respectively, and all corrected item-total correlations exceeded the accepted cut of 0.30, demonstrating high internal reliability and homogeneity. CFA corroborated the one-factor structure proposed in the original version. The Sp-CARE measure total score was significantly correlated with overall patient satisfaction (Spearman's rho 0.45, P < 0.001). Conclusion: The results support the reliability and validity of the Sp-CARE measure as a patient-rated empathy measure in the primary care setting.

This study explores differentiation of self (DoS) and its association with couple adjustment across the family life cycle, in a sample of Spanish individuals (n¿=¿506). Individuals in stage VII (nearing the end of life) revealed significantly lower levels of DoS than those in other stages, except for V (moving on at midlife). Individuals in stages V and VII also revealed lower couple adjustment than individuals in stage II (couple formation). DoS was positively associated with couple adjustment across all stages, particularly V-VII. Longitudinal studies will confirm the trend for decrease in DoS and couple adjustment. Implications for therapy are discussed.

This study aimed to determine the associations between parental monitoring and affection and three adolescent lifestyle aspects: constructive leisure, non-constructive leisure and substance use. A cross-sectional study was conducted in four countries (Chile, Mexico, Spain and Peru). Adolescents aged 12-15 self-completed a multi-purpose questionnaire. Multiple logistic regressions were performed to analyse the association between the parental monitoring and affection variables and the outcomes in terms of the children's lifestyles. The results indicate that parental monitoring is conducive to more constructive leisure and less non-constructive leisure and seems to be conducive to the prevention of substance use. Furthermore, parental affection is conducive to constructive leisure and the prevention of substance use. The discussion focuses on the fact that the family can be a protective resource associated with positive adolescent development.

This study is a multi-national follow-up to the original (Sandberg and Knestel (2011) Journal of Marital and Family Therapy, 37, 393-410) article on the process of learning Emotionally Focused Couples Therapy (EFT). A total of 102 clinicians from nine Spanish-speaking countries (Mexico, Costa Rica, Guatemala, Spain, Colombia, Argentina, Chile, Ecuador, and El Salvador) participated in the study. A comparison of results across the two studies revealed more similarities than differences. However, a few notable differences emerged from responses to qualitative questions, namely a heightened sense of appreciation for and resonance with the focus on core emotion in EFT and less frequent reports of difficulty learning and adapting to the model among Spanish-speaking therapists. These differences were consistent with common cultural values and forms of expression in Latin America and Spain. Results are discussed in terms of training, supervision, and future research as well.

Background: Healthy lifestyle adherence is associated with lower chronic disease morbidity/mortality. The role of doctors, as counselors and role models, is essential. Among physicians participating in a prospective cohort, we investigated the behavioral counseling on diet and lifestyle provided to their patients in association with their own personal behaviors. Methods: We assessed 890 doctors aged ¿65 years participating in the 'Seguimiento Universidad de Navarra' (SUN) cohort, who replied to an online questionnaire regarding their practices on behavioral counseling and drug prescription to their patients. Data were combined with previous baseline information on their personal healthy habits. Results: Among doctors, 31% reported <10 min per visit; 73% counseled 60-100% of their patients on smoking cessation, 58% on physical activity, 54% on weight control, 51% on healthy nutrition, 44% on alcohol avoidance/reduction and 28% recommended alcohol moderate consumption. The percentage of doctors that counseled 100% of their patients about lifestyle was 43% for smoking cessation, 15% for exercise and 13% for weight control and nutrition. Better doctor's adherence to the Mediterranean dietary pattern was associated with more frequent and longer nutrition counseling. Higher practice of physical activity was associated with longer time on counseling about exercise to their patients. Among doctors both current and former smoking were inversely associated with the frequency and duration of their smoking cessation/avoidance counseling practices. Conclusions: Personal behavioral changes among doctors and better training of medical doctors on a personal healthy diet and lifestyle are likely to contribute to improve the behavioral counseling given to patients.

This study seeks to validate the cross-cultural effectiveness of Emotionally Focused Couple Therapy (EFT) training in a sample of Spanish-speaking clinicians. The 28-hour formalized training for EFT was offered in six different Spanish-speaking countries, covering Europe, North America, Central America, and South America. Two hundred and seven therapists of 14 different Spanish-speaking nationalities completed pre-training assessments, 153 of them completed post-training assessments, and 92 therapists also completed the follow-up assessment. Using multilevel growth modeling, results indicated that therapists experienced significant and positive changes in terms of EFT competence (knowledge and skill acquisition), mature empathy, self-compassion, and attachment over time. Implications for transnational EFT training, specifically in Spanish-speaking countries, are discussed.

Contextual therapy posits that a truly comprehensive grasp of human existence is composed of individual and relational realities. The Relational Ethics Scale (RES) is the only validated instrument to measure relational ethics, one of the relational realities' four dimensions, which was theorized by Boszormenyi-Nagy. The RES measures people's perception about constructs of loyalty, entitlement, trust and justice in their family of origin and in their current and significant relationships. Relational ethics has been shown to have implications for mature development, psychological health and family functioning. The aim of this research was to adapt the RES for use with Spaniards residing in Spain (N = 1181). Psychometric properties were analyzed, and construct validity was assessed using the Spanish-Differentiation Self Inventory. Results obtained indicate the Spanish Relational Ethics Scale (S-RES) is a valid and reliable tool for relational ethics assessment in Spanish populations. Couple and family counselors in Spain may consider the clinical assessment of relational ethics using the S-RES in order to explore issues of fairness, trust, roles, and re-balance when working to support complex family systems. Future research directions using the newly validated S-RES are discussed.

Abstract Resumen A partir del siglo XX el ocio ha tenido un papel crucial en la sociedad, la economía, la cultura y la educación. Este hecho ha despertado un gran interés por estudiar la conexión que tiene este fenómeno con los estilos de vida, la satisfacción, el entorno, y la relación entre ocio y trabajo. Este artículo analiza la influencia del ocio en la vida de los jóvenes. En la primera parte, se realiza una revisión bibliográfica de las principales teorías sociológicas y psicológicas que explican su sentido, evolución y relación con el trabajo. En la segunda parte, se expone el modelo de desarrollo positivo, centrado más en el florecimiento del potencial de los jóvenes que en prevenir conductas de riesgo. El uso positivo del tiempo libre se basa en la realización de actividades estructuradas, con participación voluntaria, motivación intrínseca y supervisadas por adultos. Se concluye que la implicación de los jóvenes en asociaciones, organizaciones e instituciones que desarrollen actividades estructuradas de participación voluntaria o autoimplicada facilita la transición a la vida adulta, en relación con el uso constructivo del tiempo unido a un ocio libre y placentero.

Previous studies have documented the link between differentiation of self and life satisfaction. However, the underlying mechanisms explaining these associations are yet to be tested at the dyadic level. This study examined the mediating role of marital adjustment in the association between differentiation of self and life satisfaction among 113 Turkish heterosexual married couples (N=226). Analyses using the Common Fate Model demonstrated that differentiation of self was associated with higher levels of marital adjustment and life satisfaction, such that marital adjustment was positively associated with life satisfaction, and in turn, marital adjustment fully mediated this association. Implications are discussed for clinicians and cross-cultural researchers who seek to promote greater life satisfaction by targeting both differentiation and marital adjustment.

HIV-1 diversity may impact monitoring and vaccine development. We describe the most recent data of HIV-1 variants and their temporal trends in the Democratic Republic of Congo (DRC) from 1976 to 2018 and in Kinshasa from 1983-2018. HIV-1 pol sequencing from dried blood collected in Kinshasa during 2016-2018 was done in 340 HIV-infected children/adolescents/adults to identify HIV-1 variants by phylogenetic reconstructions. Recombination events and transmission clusters were also analyzed. Variant distribution and genetic diversity were compared to historical available pol sequences from the DRC in Los Alamos Database (LANL). We characterized 165 HIV-1 pol variants circulating in Kinshasa (2016-2018) and compared them with 2641 LANL sequences from the DRC (1976-2012) and Kinshasa (1983-2008). During 2016-2018 the main subtypes were A (26.7%), G (9.7%) and C (7.3%). Recombinants accounted for a third of infections (12.7%/23.6% Circulant/Unique Recombinant Forms). We identified the first CRF47_BF reported in Africa and four transmission clusters. A significant increase of subtype A and sub-subtype F1 and a significant reduction of sub-subtype A1 and subtype D were observed in Kinshasa during 2016-2018 compared to variants circulating in the city from 1983 to 2008. We provide unique and updated information related to HIV-1 variants currently circulating in Kinshasa, reporting the temporal trends of subtypes/CRF/URF during 43 years in the DRC, and providing the most extensive ...

This study comprises a first attempt to explore a cross¿cultural application of Bowen family systems theory and examines the relationship between differentiation of self and couple adjustment using measurement invariance. A sample of 2,141 individuals (n = 915 from the United States; n = 635 from Italy; n = 591 from Spain) completed measures of differentiation of self (DSI¿R; Skowron & Schmitt, J Marital Fam Ther, 29, 2003, 209) and couple adjustment (DAS; Spanier, J Marriage Fam, 38, 1976, 15). Results showed evidence of partial measurement equivalence for the DSI¿R across the three samples. Additionally, results from latent regression showed that less emotional cutoff predicted greater couple adjustment in the United States, Spain, and Italy, whereas greater emotional reactivity predicted poorer couple adjustment only in the more collectivistic cultures, Spain and Italy. Our findings are consistent with prior empirical studies, which suggest that emotional cutoff is a strong predictor of relationship adjustment. The use of measurement invariance provides a foundation for future studies to continue employing rigorous statistical methods when examining constructs across different cultures. The findings highlight culture¿specific similarities and differences in differentiation that may benefit practitioners by informing psychotherapy with individuals, couples, or families from diverse populations.

This study used an actor¿partner interdependence analytic approach to examine a theoretical model assessing whether lower differentiation of self is linked to higher psychological distress and lower dyadic adjustment. Data from 195 heterosexual Spanish couples were analyzed. Results showed significant actor effects in all variables. Regarding partner effects, women¿s emotional cutoff had a significant influence on their partner¿s psychological distress and dyadic adjustment; however, men¿s emotional cutoff had a significant relationship with their partner¿s dyadic adjustment but not psychological distress. Emotional reactivity on the other hand, the intrapersonal dimension of differentiation of self, did not manifest any partner effect. The findings provide (a) a new approach on the role of differentiation of self in intra- and interpersonal distress; (b) cross-cultural support for previous research; and (c) an integrated model for a systemic understanding of these variables, grounded in a strong theoretical framework, which explained up to 62% of model variance. Overall, our results support Bowen¿s basic assumptions and systems theory principles that a couple is an emotional unit, and suggest that interventions targeting emotional cutoff may be particularly helpful to benefit both members of the couple. Other implications for therapy and suggestions for future research are discussed.

Background: Forty-four percent of all pregnancies worldwide are unintended. Induced abortion has drawn a lot of attention from clinicians and policy makers, and the care for women requesting it has been covered in many publications. However, abortion challenges the values of many women, is associated with negative emotions, and has its own medical complications. Women have the right to discuss their unintended pregnancy with a clinician and receive elaborate information about other options to deal with it. Continuing an unintended pregnancy, and receiving the necessary care and support for it, is also a reproductive right of women. However, the provision of medical information and support required for the continuation of an unintended pregnancy has hardly been approached in the medical literature. Objective: This review presents a clinical approach to unintentionally pregnant patients and describes the information and support that can be offered for the continuation of the unintended pregnancy. Discussion: Clinicians should approach patients with an unintended pregnancy with a sympathetic tone in order to provide the most support and present the most complete options. A complete clinical history can help frame the problem and identify concerns related to the pregnancy. Any underlying medical or obstetric problems can be discussed. A social history, that includes the personal support from the patient's partner, parents, and siblings, can be taken. Doctors should also be alert of possible cases of violence from the partner or child abuse in adolescent patients. Finally, the clinician can provide the first information regarding the social care available and refer the patients for further support. For women who continue an unintended pregnancy, clinicians should start antenatal care immediately. Conclusion: Unintentionally pregnant women deserve a supportive and complete response from their clinicians, who should inform about, and sometimes activate, all the resources available for the continuation of unintended pregnancy. Forty-four percent of all pregnancies worldwide are unintended. Induced abortion has drawn a lot of attention and the care for women requesting it has been covered in many publications. However, abortion challenges the values of many women, is associated with negative emotions, and has its own medical complications. Women have the right to discuss their unintended pregnancy with a clinician and receive elaborate information about other options to deal with it. Continuing an unintended pregnancy, and receiving the necessary care and support for it, is also a reproductive right of women. However, the provision of medical information and support required for the continuation of an unintended pregnancy has hardly been approached in the medical literature. This review presents a clinical approach to unintentionally pregnant patients and describes the information and support that can be offered for the continuation of the unintended pregnancy. Clinicians should approach patients with an unintended pregnancy with a sympathetic tone. A complete clinical history can help frame the problem and identify concerns related to the pregnancy. Any underlying medical or obstetric problems can be discussed. A social history, that includes the personal support from the patient's partner, parents, and siblings, can be taken. Doctors should also be alert of possible cases of violence from the partner or child abuse in adolescent patients. Finally, the clinician can provide the first information regarding the social care available and refer the patients for further support. For women who continue an unintended pregnancy, clinicians should start antenatal care immediately.

We present a comparison between Italy, Spain, Greece, and Portugal to test the cross¿cultural validity of the Differentiation of Self Inventory Revised (DSI¿R) Scales of emotional cut¿off (EC) and emotional reactivity (ER). Our study focuses on the importance of in¿depth analyses of the differentiation of self¿constructs from a cross¿cultural perspective and reflects on the possibility of conceptualising the universality of Bowen theory in southern European countries. The study involved 1,807 healthy individuals. All participants completed the DSI¿R (Skowron & Schmitt, 2003). It was found that the measurement models had a suitable fit for each country group. Nevertheless, in our study, the two DSI¿R subscales, ER and EC, highlighted a weak invariance, specifically demonstrating only the invariance of the pattern factor loadings and the magnitude of factor loadings in the four samples. The empirical and clinical implications of these data are discussed.

Introduction: Structured and unstructured leisure are known protective and risk factors, respectively, for alcohol consumption during adolescence. However, little is known about the interaction between the two leisure types and alcohol consumption. Method: A cross-sectional study was performed among high-school students in El Salvador and Peru. Schooled adolescents, aged 13¿18 (N=5,640), completed a self-administered questionnaire about risk behaviors, including their leisure activities and whether they had consumed alcoholic beverages. They were classified into tertiles of the amount of time of both structured and unstructured activities. A non-conditional multivariate logistic regression was conducted to evaluate the association of both types of leisure with alcohol consumption. We also used a likelihood ratio test to assess the potential interaction of structured and unstructured leisure time in alcohol consumption. Results: Alcohol consumption was much more frequent among adolescents in the highest tertile of unstructured leisure time compared to the lowest one, and less frequent among those from the highest tertile of structured leisure time compared to the lowest one. We did not find an interaction effect between structured and unstructured leisure time with regard to initiation of alcohol consumption. Discussion: The study suggests that structured leisure is not enough to compensate for the possible harmful effect of unstructured leisure. Parents, educators and policy

Recent studies have shown different results in identifying which parenting style is the most beneficial for children, which has encouraged certain authors to wonder whether parental control is still needed for optimal parenting. As such investigations have been conducted with different measuring instruments, it is necessary to check whether the use of different instruments leads to different results. In order to figure this out, a systematic review of the recent literature (Web of Science and Scopus, 2000¿2017) was carried out. This review found that, using certain instruments, parental control is associated with better outcomes in children, while using certain others, control is associated with worse outcomes. The difference seems to be in the way of measuring parental control.