RESUMO A relação da eficiência nutricional com a idade e o peso à puberdade e as características reprodutivas foram estudadas em 35 novilhas F1 Holandês x Gir, em ensaios usando o consumo alimentar residual (CAR) nos períodos pós-desaleitamento (PD) e pós-puberdade (PP). Novilhas PD (P<0,0001) e PP (P<0,001) foram ranqueadas como de alta, intermediária e baixa eficiências e apresentaram CAR de -0,259 -0,014 e 0,346kg/dia e -0,848 -0,096 e 0,842kg/dia, respectivamente. Novilhas PD diferiram (P<0,05) na idade à puberdade entre ranques de alta, intermediária e baixa eficiências, em média, aos 339,7; 346,4; 315,3 dias, respectivamente. Os pesos à puberdade de novilhas PD com alta, intermediária e baixa eficiências foram, em média, de 321±28,1kg e não diferiram (P>0,05) entre CAR. Não foi verificada correlação entre diâmetro folicular, taxa de crescimento do folículo, número de ondas foliculares no ciclo estral e taxa de gestação à primeira IA com o CARPD ou CARPP. Novilhas F1HG selecionadas para CAR com baixa eficiência podem ter idade à puberdade 10 dias a mais, quando comparadas às novilhas de alta eficiência para CAR. Não foi verificado que novilhas selecionadas para alta ou baixa eficiências alimentares, usando CAR, tivessem algum impacto negativo sobre características reprodutivas avaliadas.

ABSTRACT The relationship between nutritional efficiency and age and weight at puberty and reproductive traits was studied in 35 F1 Holstein x Gyr heifers, in trials using residual food consumption (CAR) in the post-weaning (PW) and post-pubertal (PP) periods. PD heifers (P<0.0001) and PP (P<0.001) were classified as high, intermediate and low efficiencies and presented CAR of -0.259 -0.014 and 0.346kg/day and -0.848 -0.096 and 0.842kg/day, respectively. PD heifers differed (P<0.05) in age at puberty between high, intermediate and low efficiencies, on average, at 339.7, 346.4 and 315.3 days, respectively. The weight at puberty of PD heifers with high, intermediate and low efficiencies were, on average, 321±28.1kg and did not differ (P>0.05) between CAR. No correlation was found between follicular diameter, follicle growth rate, number of follicular waves in the estrous cycle and pregnancy rate at 1st AI with the CARPD or CARPP. F1HG heifers selected for CAR with low efficiency can be aged at puberty 10 days longer when compared to high-efficiency heifers for CAR. These results did not show that heifers selected for high or low food efficiency, using CAR, had negative impact on the reproductive characteristics evaluated.

In recent years, Spain has experienced a large increase in the immigrant population. This phenomenon has been a challenge for pediatricians who have had to adapt to this new reality. Today, many of the difficulties and challenges regarding immigrant children have more to do with communication problems and different conceptions of health and disease, than with imported diseases or specific health problems. According to this, we speak of cultural competence as a set of skills, attitudes and behaviours in which the practitioner should be trained in order to provide a sensitive, empathetic, flexible and patient friendly care, which also includes an effective patient-centred communication. They are cornerstones of cultural competence, together with sensitivity to differences and to others, and the ability to listen and to know how to ask. Those abilities and skills are not different from the necessary ones to take appropriate care of our patients in general, but to apply them is necessary for a patient-centred approach to the immigrant population. Therefore the further development of these skills will improve our attention to the local population. In our attention to immigrants we encounter difficulties and barriers to overcome. Within these barriers we face problems of attitude, prejudice, mistrust, language barriers, short time in consultations, lack of training in specific areas of the immigrant population, etc. Identifying these barriers and seeking solutions to these difficulties is the target of this review.

Los últimos años, en España, ha habido un gran aumento de la población inmigrante. Este fenómeno ha supuesto un reto para los pediatras que han tenido que adaptarse a esta nueva realidad. En la actualidad, muchas de las dificultades y retos que nos plantea el niño inmigrante tienen más que ver con problemas de comunicación y diferentes concepciones de la salud y la enfermedad, que con patologías importadas o problemas de salud concretos. En la línea de lo anterior, se habla de la competencia cultural como un conjunto de habilidades, actitudes y comportamientos, en los que el profesional debería estar entrenado para proporcionar unos cuidados sensibles, empáticos, flexibles y respetuosos con el paciente, que implican una comunicación centrada en el paciente efectiva. Son pilares básicos de la competencia cultural, la sensibilidad hacia las diferencias y hacia el otro, y la capacidad de escucha y saber preguntar. No se trata de habilidades diferentes a las necesarias para hacer una atención adecuada a nuestros pacientes en general, sino de aplicar las habilidades necesarias para un enfoque centrado en el paciente a la población inmigrante. Por lo tanto profundizar en estas habilidades nos hará mejorar nuestra atención a la población autóctona. En nuestra atención al inmigrante, nos encontramos con dificultades y barreras para superar estas dificultades. Dentro de estas barreras nos encontramos con problemas de actitud, prejuicios, recelos, barreras lingüísticas, escaso tiempo en las consultas, falta de formación en temas específicos de la población inmigrante, etc. Identificar estas barreras y buscar soluciones a esas dificultades son los objetivos de la presente revisión.