No abstract

ObjectiveStunting is a common cause of early child developmental delay; Guatemala has the fourth highest rate of stunting globally. The goal of this study was to examine the impact of an intensive community health worker-led complementary feeding intervention on early child development in Guatemala. We hypothesised that the intervention would improve child development over usual care.DesignA substudy from a larger individually randomised (1:1 allocation ratio), parallel-group superiority trial, with blinding of study staff collecting outcomes data.SettingRural, indigenous Maya communities in Guatemala.Participants210 stunted children (height-for-age z-score ≤−2.5) aged 6–24 months, previously randomised to usual care (106) or an intensive complementary feeding intervention (104). 84 in the intervention and 91 in the usual care arm agreed to participate.InterventionsCommunity health workers conducted monthly home visits for 6 months, providing usual care or individualised complementary feeding education.Main outcome measuresThe primary outcomes were change in z-scores for the subscales of the Bayley Scales of Infant Development (BSID), Third Edition.Results100 individuals were included in the final analysis, 47 in the intervention and 53 in the usual care arm. No statistically significant differences in age-adjusted scores between the arms were observed for any subscale. However, improvements within-subjects in both arms were observed (median duration between measurements 189 days (IQR 182–189)). Mean change for subscales was 0.45 (95% CI 0.23 to 0.67) z-scores in the intervention, and 0.43 (95% CI 0.25 to 0.61) in the usual care arm.ConclusionsAn intensive complementary feeding intervention did not significantly improve developmental outcomes more than usual care in stunted, indigenous Guatemalan children. However, both interventions had significant positive impacts on developmental outcomes.Trial registration numberNCT02509936.StageResults.

Due to the scarcity of evaluation instruments on the construct of difficulties in emotional regulation in the Ecuadorian university context, the objective of the present study was to adapt linguistically and to study the psychometric properties of the Difficulty Scale in Emotional Regulation (DERS) in a sample of Ecuadorian university students. A non-probability sample of 1172 participants between 17 and 32 years of age (M = 21.99; DT = 2.49), which consisted of 58.6% women and 41.4% men, was used. The research was carried out in three stages. The first study evaluated the Ecuadorian linguistic adaptation of the scale. The second study referred to the factorization by main axes identifying five factors (Lack of emotional understanding; Limited access to regulation strategies; Difficulties in impulse control; Interferences in goal-directed behaviors; Lack of emotional clarity) theoretically interpretable, which explain 49.22% of the variance. The third study developed a confirmatory factor analysis that specified an acceptable fit of the model (GFI = .95; AGFI =.95; NFI = .94; RMR = .11). The reliability coefficients are acceptable as .90 Cronbach’s alpha and .91 McDonald’s omega. In conclusion, it is mentioned that the Ecuadorian version of the DERS in a university sample exhibits good psychometric characteristics of internal structure and responses.

La supervisión clínica sostenida en las alianzas de trabajo de supervisión se destaca a través de diversos contextos profesionales resaltando su papel fundamental y crítico entre los múltiples enfoques de la práctica contemporánea. Estas alianzas involucran una relación de trabajo co-construida que idealmente logra ser más grande que la suma de sus partes, y representa un componente fundamental de la supervisión. Cuando se trabajan estas alianzas, surgen retos sustanciales junto a oportunidades complejas relacionadas a la persona que es supervisada, a la que supervisa y la que es cliente. Frecuentemente, las alianzas de trabajo en supervisión estimulan dimensiones personales, profesionales y contextuales de relevancia significativa para la práctica competente y ética de la supervisión y su reconocimiento contextual las cuales están estrechamente relacionadas con la auto-revelación, la seguridad cultural y las competencias multiculturales.