The scientific system of human core balance in sports / O sistema científico do equilíbrio do core humano nos esportes / El sistema científico del equilibrio del core humano en los deportes

ABSTRACT Introduction: The human brain controls the body's balance, actinh on the muscle tissues of the body and thus controlling the balance of its center of gravity. Objective: To analyze 6 indicators that affect the brain's ability to control the body's balance and to verify the important muscle areas of the human body and prove that strength training can help improve the body's balance ability. Methods: This article selected young university students with the same physical fitness as sample and analyzed the factors that affect the body's strength and balance using statistical models. Results: Strength training can effectively improve the body›s balance when standing. Conclusion: Training the brain to control the body is mainly to exercise strength, stability, balance, and other abilities of human muscle tissue. Using this kind of exercise method can effectively improve the stability of the human body. Targeted training can also enhance the brain's ability to control the balance of the body. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: O cérebro humano controla o equilíbrio do corpo, agindo sobre seus tecidos musculares e, assim, controlando o equilíbrio de seu centro de gravidade. Objetivo: Analisar seis indicadores que afetam a capacidade do cérebro de controlar o equilíbrio do corpo, avaliar áreas musculares relevantes do corpo humano, e provar que atividade física voltada à força pode melhorar o equilíbrio do corpo. Métodos: Esse artigo selecionou como amostra jovens estudantes universitários com preparo físico similar, e analisou quais fatores afetam de maneira relevante a força e o equilíbrio do corpo por meio de modelos estatísticos. Resultados: Treinamentos de força podem efetivamente melhorar o equilíbrio do corpo quando de pé. Conclusão: Treinar o cérebro para controlar o corpo significa, principalmente, treinar a força, a estabilidade, o equilíbrio, e outras capacidades dos tecidos musculares humanos. O uso dessa metodologia de atividade física pode efetivamente aprimorar a estabilidade do corpo humano. O treinamento direcionado também pode melhorar a capacidade do cérebro de controlar o equilíbrio do corpo. Nível de evidência II; Estudos terapêuticos - investigação do resultado de tratamentos.

RESUMEN Introducción: El cerebro humano controla el equilibrio del cuerpo, actuando sobre sus tejidos musculares y, así, controlando el equilibrio de su centro de gravedad. Objetivo: Analizar seis indicadores que afectan la capacidad del cerebro de controlar el equilibrio del cuerpo, evaluar áreas musculares relevantes del cuerpo humano y probar qué actividad física centrada en la fuerza puede mejorar el equilibrio del cuerpo. Métodos: Este artículo seleccionó como muestra jóvenes estudiantes universitarios con preparación física similar y analizó cuáles factores afectan de manera relevante la fuerza y el equilibrio del cuerpo por medio de modelos estadísticos. Resultados: Entrenamientos de fuerza pueden efectivamente mejorar el equilibrio del cuerpo al estar de pie. Conclusión: Entrenar el cerebro para controlar el cuerpo significa, principalmente, entrenar la fuerza, la estabilidad, el equilibrio y otras capacidades de los tejidos musculares humanos. El uso de esta metodología de actividad física puede, efectivamente, mejorar la estabilidad del cuerpo humano. El entrenamiento dirigido también puede optimizar la capacidad del cerebro de controlar el equilibrio del cuerpo. Nivel de evidencia II; Estudios terapéuticos - investigación del resultado de tratamientos.

Exploration and reflection on evaluation methodology of human use experience for new Chinese drug development / 中国中药杂志

The "triple combination" review system provides an opportunity for the transformation of human use experience into new Chinese drugs. However, there are some methodological and technical limitations in the assessment of human experience. Hence, the efficacy and safety evaluation methods should be established in accordance with the characteristics of Chinese herbs. This study summarized some evidence-based methodology to promote the transformation of human use experience to new Chinese drugs, mainly including the individualized pragmatic randomized controlled trial(RCT), cluster RCT, single-case RCT, single arm RCT with objective performance criteria, and partially nested RCT. As the real world data can be used to support the transformation of human experience, attention should be paid to convenient and efficient collection of data, prudent selection of design types, and adoption of appropriate ana-lysis methods to deal with confounding bias, including multi-factor regression model and propensity score. The newly proposed mixed research method can also be utilized to assess the human use experience, which is suitable for mining the theory of traditional Chinese medicine(TCM) and expert experience from different aspects. Meanwhile, considering the study design requirements and TCM cha-racteristics, this study put forward the common problems and solutions in the development of new Chinese drugs based on human use experience, including how to select the feasible outcome indicators, how to collect prescription data in the case of herb and dosage adjustment, and how to evaluate the comprehensive effectiveness of TCM from the perspective of "combination of disease and syndrome".

Assistência à saúde mental no Brasil: estudo multifacetado em quatro grandes cidades / Mental healthcare in Brazil: a multifaceted study in four large cities / Asistencia en salud mental en Brasil: estudio multifacético en cuatro grandes ciudades

O objetivo deste estudo foi avaliar as características das redes de saúde de quatro grandes municípios brasileiros (Campinas, Fortaleza, Porto Alegre e São Paulo) no que diz respeito à prestação de cuidados em saúde mental. Foram usados como desfechos: (i) local de identificação do problema de saúde mental; (ii) atendimento em saúde mental na atenção básica; (iii) assistência farmacêutica em saúde mental; e (iv) reinserção social. Trata-se de um estudo analítico de métodos mistos, de abordagem concomitante e sequencial, conduzido com 10 gestores e 1.642 usuários de Centros de Atenção Psicossocial (CAPS) dos municípios citados. Observou-se a persistência de serviços de alta complexidade, tais como os hospitais, como locais de identificação inicial dos problemas de saúde mental em Campinas (40% dos usuários) e Fortaleza (37%); baixa proporção de tratamento de saúde mental na atenção básica (Fortaleza, 23%); diferenças entre os municípios no que diz respeito à prescrição de medicamentos psicotrópicos na atenção básica (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%), bem como na falta dos medicamentos prescritos (maior em Fortaleza, 58%; menor em Campinas, 28%); e fragilidade em geral na retomada de atividades laborais (menor em São Paulo, 17%; maior em Campinas, 39%), havendo melhores resultados em geral em relação a atividades religiosas e de lazer (maiores em São Paulo, 53% e 56%, respectivamente). É um estudo que contribui para a discussão do panorama brasileiro da assistência à saúde mental, com evidências da persistência de desigualdades no contexto nacional, e aponta lacunas em algumas configurações das redes de saúde mental com potenciais para melhor desempenho e seguimento longitudinal.

This study aimed to assess characteristics of healthcare networks in four large Brazilian cities (Campinas, Fortaleza, Porto Alegre, and São Paulo), in the provision of mental healthcare. The following outcomes were used: (i) place of identification of the mental health problem; (ii) mental healthcare in primary care; (iii) pharmaceutical care in mental health; and (iv) social rehabilitation. This is a mixed-methods study with a concurrent and sequential approach, conducted with 10 administrators and 1,642 users of Centers for Psychosocial Care (CAPS, in Portuguese) in the four cities. The study showed the persistence of high-complexity services such as hospitals as the site for initial identification of mental health problems in Campinas (40% of users) and Fortaleza (37%); low proportion of mental health treatment in primary care (Fortaleza, 23%); differences between cities in psychotropic medication prescription in primary care (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%) and in shortages of prescribed medication (higher in Fortaleza, 58%; lower in Campinas, 28%); and overall frailty in enabling return to work (lower in São Paulo, 17%; higher in Campinas, 39%), with better overall results regarding religion and leisure activities (higher in São Paulo, 53% and 56%, respectively). The study contributes to the discussion of the Brazilian scenario of mental healthcare, with evidence of persistent inequalities in the national context, pointing to gaps in some mental healthcare network configurations with the potential for better performance and longitudinal follow-up.

El objetivo de este estudio fue evaluar características de las redes de salud en cuatro grandes municipios brasileños (Campinas, Fortaleza, Porto Alegre y São Paulo), en lo que se refiere prestación de cuidados en salud mental. Se utilizaron como resultados: (i) lugar de identificación del problema de salud mental; (ii) atención en salud mental en la atención básica; (iii) asistencia farmacéutica en salud mental; y (iv) reinserción social. Se trata de un estudio analítico con métodos mixtos, de enfoque concomitante y secuencial, realizado con 10 gestores y 1.642 usuarios de Centros de Atención Psicosocial (CAPS) de los municipios citados. Se observó la persistencia de servicios de alta complejidad, tales como hospitales, respecto al lugar de identificación inicial del problema de salud mental en Campinas (40% de los usuarios) y Fortaleza (37%); baja proporción de tratamiento de salud mental en la atención básica (Fortaleza, 23%); hubo diferencias entre los municipios en lo que se refiere a la prescripción de medicamentos psicotrópicos en la atención básica (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%), así como en la falta de medicamentos prescritos (mayor en Fortaleza, 58%; menor en Campinas, 28%); y fragilidad en general en el retorno al trabajo (menor en São Paulo, 17%; mayor en Campinas, 39%), existiendo mejores resultados en general, en relación con la religión y ocio (mayores en São Paulo, 53% y 56%, respectivamente). Se trata de un estudio que contribuye a la discusión del panorama brasileño de la asistencia en salud mental, con evidencias de la persistencia de desigualdades en el contexto nacional, además apunta lagunas en algunas configuraciones de las redes de salud mental con potencial para un mejor desempeño y seguimiento longitudinal.

Evaluación del plan de prevención y control del cólera post-huracán Sandy / Evaluation of the Plan for Prevention and Control of Cholera After Hurricane Sandy

Introducción: el cólera es una enfermedad que se conoce desde tiempos muy remotos y su prevención y control es motivo de atención desde esa época. Objetivo: evaluar el cumplimiento de plan de prevención y control del cólera, en la provincia de Santiago de Cuba en el brote de cólera post huracán Sandy. Método: se realizó una investigación en sistema y servicios de salud, durante el periodo comprendido de julio a octubre de 2013. Se realizó un muestreo estratificado polietápico, constituido por 48 consultorios médicos, 44 centros de salud y otros. Se utilizó la metodología de evaluación de la Escuela Nacional de Salud Pública en la cual se trazaron criterios, indicadores y estándares por un grupo de expertos. Se aplicaron encuestas, se realizó revisión documental y observaciones. Resultados: la evaluación de la estructura resultó inadecuada por insuficiente existencia de recursos materiales como guantes, material para la desinfección, escaso transporte para los pacientes, etc. En el proceso, los criterios con mayores desviaciones entre lo obtenido y el estándar prefijado resultaron ser: el funcionamiento del equipo de respuesta rápida, el registro de pacientes atendidos y la identificación de los contactos. En el componente de resultados, la satisfacción de los proveedores de salud, se calificó de adecuada. El plan de prevención y control del cólera no se cumple, con el 70% de los criterios trazados como adecuados. Conclusiones: el plan de prevención y control evaluado resultó inadecuado, dado por problemas de estructura y del proceso que, aunque no genera grandes insatisfacciones del personal de la salud, existen dificultades con la intersectorialidad que pueden influir en la disminución o eliminación de la enfermedad del territorio evaluado.

Introduction: cholera is a disease known since ancient times and its prevention and control has been the subject of attention since then. Objective: to evaluate the implementation of this plan, in the province of Santiago de Cuba in the cholera outbreak after Hurricane Sandy. Method: a research in Health Service System was conducted during the period from July to October 2013. A multistage stratified sampling, comprising 48 medical offices, 44 health centers, and others were performed. Assessment methodology of the National School of Public Health where criteria, indicators and standards were drawn by a group of experts was used. Surveys, document review and observations were applied for the study. Results: the evaluation of the structure was inadequate because of insufficient existence of material resources as gloves, equipment for disinfection, poor transportation for patients, etc. In the process, the criteria for larger deviations between the proceeds and the preset standard were Operation Rapid Response Team, the Register of treated patients and contact tracing and the Dimension of results, satisfaction of health care providers are properly qualified. These results place the evaluation plan for prevention and control of cholera, as inadequate as it does not meet the 70% criterion paths as adequate. Conclusions: evaluated of Prevention and Control Plan was inadequate, due to problems of structure and process, but does not generate large dissatisfactions of health personnel, there are intersectoriality difficulties that can influence the reduction or elimination of the disease in the territory evaluated.

Métodos para Avaliação de Sistema de Informação em Saúde / Methods for Evaluation of Information Systems in Healthcare / Métodos para la Evaluación de los Sistemas de Información en Salud

Objetivos: Definir o que é a avaliação de SIS, descrevendo os aspectos considerados e os métodos aplicados. Método: Revisão sistemática na base de dados PubMed no período de janeiro de 2004 a junho de 2014. Resultados: A maioria dos estudos avaliou os aspectos da usabilidade, eficácia e qualidade da informação. Em 29% dos estudos foi encontrada aplicação de métodos combinados com: satisfação e aceitação do usuário; questionários; usabilidade; e entrevista com o grupo. Avaliação da funcionalidade; do impacto; usabilidade e desempenho clínico/diagnóstico são utilizados de forma isolada. Conclusão: É fundamental ter bem claro o que será avaliado no SIS, sendo essencial conhecer os aspectos envolvidos, os métodos existentes e como são aplicados.

Objectives: To define what is the assessment of HIS, describing the aspects considered and the methods applied. Methods: Systematic review in PubMed database from January 2004 to June 2014. Results: Most studies evaluating aspects of usability, efficacy and quality of information. In 29% of studies were applied methods together with: satisfaction and user acceptance; questionnaires; usability; and interview with the group. Reviewed functionality; impact; usability and clinical/diagnostic performance were generally used separated. Conclusion: It is essential to have clear what it will be evaluated in the SIS, and to know the aspects involved, the existing methods and how they are applied.

Objetivos: Definir qué es la evaluación del SIS, describir los aspectos considerados y los métodos aplicados. Métodos: Revisión sistemática de la base de datos PubMed de enero 2004 a junio 2014. Resultados: La mayoría de los estudios evaluaron los aspectos de usabilidad, la eficacia y la calidad de la información. En 29% de los estudios se encontró la aplicación de métodos combinados con: satisfacción y aceptación de los usuarios; cuestionarios; facilidad de uso; y una entrevista con el grupo. La evaluación de  funcionalidad; impacto; usabilidad y el rendimiento clínico / diagnóstico se utilizan de forma aislada. Conclusión: Es esencial tener claro los objetivos de la evaluación del SIS, además es esencial conocer los aspectos involucrados, los métodos existentes y cómo éstos son aplicados.

A new generation of lipoprotein(a)in clinical application and performance evaluation method for the detection of particles per unit / 国际检验医学杂志

Objective To evaluate the clinical significance of the International Federation of Clinical Chemistry and Laboratory Medicine international(IFCC) reference reagent(SRM2B) standardized ,particles unit method in detecting the lipoprotein(a)[Lp (a)] .Methods Precision ,linearity ,clinical reportable range ,reference interval index of total number of particles in the kit express-ing Lp(a) by nmol/L were evaluated ,and compared with the kit expressed Lp(a) by mg/L .At the same time serum alanine amin-otransferase(ALT) ,aspartate aminotransferase(AST) ,total bilirubin(TBIL) ,UREA ,creatinine(CREA) ,triglycerides(TG) ,total cholesterol(CHOL) ,high-density lipoprotein cholesterol(HDL-C) ,low density lipoprotein cholesterol(LDL-C) of all the subjects were detected and the correlations of them between LP(a) were analyzed .Results The method with-run coefficient of variation (CV)<1 .5% ,between-run CV< 2 .0 .Within the scope of 0 .6 -236 .0 nmol/L the linear was good(r2 = 0 .996 2) .Reportable range:7-720 nmol/L ,normal reference range <75 nmol/L .With a total mass(mg/L) said good correlation between content Lp(a) kit .The correlation of Lp (a) and ALT ,AST ,TBIL ,UREA ,CERA ,TG ,CHOL ,HDL-C ,LDL-C of were -0 .120 ,-0 .091 ,-0 .372 ,-0 .096 ,-0 .087 ,0 .056 ,0 .263 ,0 .226 ,0 .159 .Conclusion This methods shows good performance ,and without interfer-ence from serum ALT ,AST ,UREA ,CERA ,TG ,HDL-C ,LDL-C levels ,but affected by the levels of serum TBIL and CHOL .It could be traced to the IFCC international reference methods and reference materials(SRM2B) ,which isn′t influenced by Lp(a) poly-morphisms ,detects Lp(a) particle number really ,expressed Lp(a) protein with nmol/L accurately ,helps evaluating clinical cardio-vascular disease risk ,and increases the comparability among different clinical research data .

The application of different linear evaluation method for clinical chemistry measurement / 国际检验医学杂志

Objective To explore the application of different linear evaluation methods for clinical chemistry measurement .Meth‐ods The analytical measurement ranges of clinical common items ,including alanine aminotransferase(ALT) ,creatine kinase(CK) , glucose(Glu) ,urea(Urea) and uric acid(UA) were established by using visual method ,modified Doumas method ,and according to′Guide to linearity evaluation of clinical chemistry analyzers′(health profession standard method) and Clinical and Laboratory Stand‐ards Institute(CLSI) EP6‐A document(EP6‐A method) .Results The visual method shown that the expected values and the meas‐ured values of these inspection items were probably in a straight line .The modified Doumas method shown that nonlinearity be‐tween expected values and measured values of CK was found ,but linearity was evaluated when discarding the last two points ;and the rest of inspection items all had linearity .The health profession standard method indicated that nonlinearities between expected values and measured values of CK and Urea were found ,but could not determine whether the nonlinearities of the two items were clinically acceptable ;and the rest of inspection items all had linearity .The EP6‐A method shown that linearities were directly found between expected values and measured values of ALT ,Glu and UA ,while CK and Urea had clinical acceptable linearities and linear‐ities were evaluated when discarding the maximum values .Conclusion The linearity evaluation is integrated with clinical objectives through EP6‐A document .Through setting methodology allowable deviation ,the EP6‐A method could expand the scope of accredi‐tion of linearity within the clinical acceptable range ,which has higher clinical practicability .

Uso de indicadores indigestíveis obtidos in situ e in vivo para determinar a digestibilidade de nutrientes em equinos / The use of indigestible markers obtained in situ and in vivo to determine digestibility of nutrients in equine

Objetivou-se estudar a viabilização dos indicadores internos, celulose (CELi) e lignina (LIGi) indigestíveis, obtidos pelas técnicas in situ e in vivo, para predizer a digestibilidade de nutrientes em equinos. Foram utilizados quatro cavalos castrados, por meio de delineamento em blocos ao acaso. Os tratamentos consistiram de metodologias de avaliação de digestibilidade, como a coleta total de fezes (CT) e o uso de indicadores internos, CELi e LIGi, obtidos pelas técnicas in situ (IS) na cavidade ruminal de bovinos e in vivo (IV) nos equinos, por meio da técnica do saco de náilon móvel (TSNM), totalizando cinco tratamentos. A ingestão diária de MS foi de 2,0 por cento do peso vivo de feno de coast-cross. A CELi-IV promoveu a melhor taxa de recuperação do indicador, igualando-se à CT, em 100,31 por cento, enquanto a LIGi resultou nas piores taxas, na média 76,45 por cento, para ambas as técnicas (P<0,05). As estimativas dos coeficientes de digestibilidade dos nutrientes foram adequadamente preditas pela CELi, obtidos IS e IV em que os valores observados foram de 46,41, 48,16, 46,90, 47,92 e 45,51 por cento para MS, MO, PB, FDN e EB, respectivamente. Concluiu-se que a CELi pode ser obtida in vivo por meio da TSNM em equinos, para predizer a digestibilidade de nutrientes...

The objective of this paper was to study the use of the internal indigestible cellulose (CELi) and lignin (LIGi) markers, obtained in situ or in vivo, to predict the apparent digestibility of nutrients in horses. Four castrated horses were utilized in a randomized blocks experimental design. Treatments consisted of different digestibility determination methodologies: total feces collection (TC) and use of CELi and LIGi internal markers obtained by the in situ (IS) incubation in bovine rumen and in vivo (IV) by the mobile nylon bag technique (MNBT) with horses, resulting in five treatments. The diet consisted exclusively of coast-cross hay and the average daily dry matter intake corresponded to 2.0 percent of the BW of the horses. The CELi-IV resulted in the best marker recuperation rate (100.31 percent), being similar to the control method; while the LIGi resulted in low recuperation rates (76.45 percent) for both techniques (P<0.05). The nutrients' digestibility coefficients were effectively predicted by CELi, obtained in situ or in vivo, with average values of 46.41, 48.16, 46.90, 47.92 and 45.51 percent for DM, organic matter, crude protein, neutral detergent fiber and crude energy, respectively. It can be concluded that CELi may be obtained in vivo by MNBT in horses to predict the nutrients' digestibility coefficients...

Avaliação de habilidades sensório-motoras em ambientes de realidade virtual para treinamento médico: uma revisão sistemática / Evaluation of sensorimotor skills in virtual reality environments for medical training: a systematic review / Evaluación de las habilidades motoras y sensoriales en entornos de realidad virtual para laformación médica: una revisión sistemática

Estudos sobre as contribuições oriundas do campo de desenvolvimento de Habilidades Sensório-Motoras (HSM) são imprescindíveis para a área de treinamento médico. Considerando experiências encontradas especialmente nesse contexto, a proposta deste trabalho consiste em uma investigação que utiliza um processo de Revisão Sistemática (RS) para recuperar o estado da arte sobre metodologias de avaliação de aquisição de HSM. Com a RS foi possível identificar métricas que são usadas em estratégias de avaliação de aquisição de HSM tanto em ambientes reais quanto virtuais. Após a identificação dessas métricas, desenvolveu-se uma análise para categorizá-las, de acordo com o seu grau de similaridade e contextos de aplicação. Nesse sentido, o estudo revela possíveis métricas que contribuirão para criação de uma nova metodologia de avaliação de aquisição de HSM para ambientes de Realidade Virtual.

Studies on the contributions from the sensorimotor skills are essential to the medical training area. Considering experiences found in this particular context, the goal of this paper is an investigation that uses a Systematic Review (SR) process in order to retrieve the state of the art in relation to methodologies to evaluate the skills acquisition. The SR made it possible to identify metrics that are used to evaluate strategies of SMS acquisition, both in real environments (RE) as well as in virtual environments. After identifying these metrics, an analysis was developed to categorize them according to their similarities and application context. In this sense, the study reveals the metrics that will contribute to the creation of a new evaluation methodology of SMS acquisition for Virtual Reality environments.

Los estudios sobre la contribución del desarrollo del campo de las Habilidades Motoras y Sensoriales  (HSM) son indispensables para la formación médica. Teniendo en cuenta las experiencias vividas, especialmente en este contexto, la propuesta consiste en una investigación que utiliza un proceso de Revisión Sistemática (RS) para recuperar el estado de la técnica sobre metodologías de evaluación para la adquisición de HSM. Para ello, tuvimos que desarrollar una revisión de la literatura existente, identificando indicadores que se utilizan a menudo en las estrategias de evaluación de la adquisición de HSM tanto en entornos reales como em entornos virtuales. Después de identificar estos parámetros, estos fueron analisados para clasificarlos según su grado de similitud, y contextos de aplicación. Así, el estudio revela posibles métricas que contribuirán para la creación o formulación de una nueva metodología de evaluación de HSM en entornos de Realidad Virtual (RV).

Comparison of Benefit Estimation Models in Cost-Benefit Analysis: A Case of Chronic Hypertension Management Programs

PURPOSE: Cost-benefit analysis is one of the most commonly used economic evaluation methods, which helps to inform the economic value of a program to decision makers. However, the selection of a correct benefit estimation method remains critical for accurate cost-benefit analysis. This paper compared benefit estimations among three different benefit estimation models. METHODS: Data from community-based chronic hypertension management programs in a city in South Korea were used. Three different benefit estimation methods were compared. The first was a standard deterministic estimation model; second, a repeated-measures deterministic estimation model; and third, a transitional probability estimation model. RESULTS: The estimated net benefit of the three different methods were $1,273.01, $-3,749.42, and $-5,122.55 respectively. CONCLUSION: The transitional probability estimation model showed the most correct and realistic benefit estimation, as it traced possible paths of changing status between time points and it accounted for both positive and negative benefits.

Status of Clerkship Education and Its Evaluation in Korean Medical Schools / 한국의학교육

PURPOSE: The aim of this study is to identify the status of clerkship education and its evaluation in Korea. METHODS: Questionnaires were sent to 943personnel in 23clinical departments of 41medical schools nationwide from April, 1 to April 10, 2004. We analyzed the 638 questionnaires that were collected from 39medical schools. RESULTS: The most frequently used methodologies for clerkship education were small group lecture(17.1%), observation of ambulatory care(15.7%), seminar(12.9%), observation and support of operation(12.4%), ward rounding(12.1%). The relative proportion of educational methodologies was varied according to the type of clinical departments. Most of the clinical clerkship activity was conducted in the university hospital. Also, the clerkship activities were educated by professors(57.8%), fellows(9.1%), residents(30.6%) and others(2.5%). The evaluation methods were written exam(21.8%), attendance(17.5%), report(14.0%), and oral exam(12.0%). In terms of evaluating items, acquirement of clinical knowledge has been mainly tested. However, students' ability to communicate, build human relationship, and clinical skills has been less frequently evaluated in most of medical schools. CONCLUSION: It is most likely that the current status of clerkship education and its evaluation in Korea is focused on the education and assessment of clinical knowledge. To improve this, the following areas need to be enriched: interaction between faculty and students, experience-based clerkship, effective feedback, time management, objectivity of evaluation, performance evaluation.

Evaluación epidemiológica del impacto de los contaminantes del aire: Propuesta metodológica

La medición del impacto de los contaminantes atmosféricos sobre la salud se realiza a través de funciones exposición-respuestas (FERs), las que permiten estimar la proporción de sujetos afectados en la población. El presente trabajo tiene como objetivos definir criterios metodológicos para la determinación de FERs, resumir el análisis de la aptitud de los estudios epidemiológicos nacionales con este propósito y proponer una serie de FERs basadas en evidencias nacionales y extranjeras para su empleo en evaluaciones de impacto. Se exponen los criterios metodológicos con vista a la formulación de FERs para contaminantes del aire a partir de estudios epidemiológicos mediante la determinación de la pendiente concentración-respuesta, y se asume que las FERs constituyen funciones lineales, sin umbral; se expone la metodología adoptada para evaluar la aptitud de estudios para el establecimiento de FERs. Los resultados muestran que numerosos estudios epidemiológicos nacionales han reportado asociaciones entre contaminantes del aire y morbilidad respiratoria aguda y crónica, aunque solo en tres de ellos han sido expuestas las FERs. Los principales problemas y limitaciones identificados incluyen: predominio de estudios descriptivos, inadecuada evaluación de la exposición por dificultades en el monitoreo de contaminantes o estimadas mediante modelos de dispersión de precisión incierta y evaluación estadística con débil componente epidemiológico (análisis principalmente bivariado, sin control de posibles factores de confusión). Se propone una selección de FERs para mortalidad y morbilidad, dirigida a su empleo preliminar en evaluaciones de impacto en salud, previa fundamentación de su aptitud.

The measurement of the impact of air pollutants on health is carried out through exposure-response functions (ERFs), which allow to estimate the proportion of affected subjects in the population. The aim of the present paper is to define the methodological criteria for the determination of ERFs, to summarize the analysis of the aptitude of national epidemiological studies with this purpose and to propose a series of ERFs based on national and international evidences for their use in impact evaluations. The methodological criteria are explained in order to formulate FERs for air pollutants, starting from epidemiological studies by the determination of the concentration-response slope. It is assumed that FERs are lineal functions without threshold. The methodology adopted to evaluate the aptitude of of the studies for the establishment of FERs is exposed. The results show that several national epidemiological studies have reported associations between air pollutants and acute and chronic respiratory morbidity, eventhough only in three of them ERFs have been exposed. The main problems and limitations identified include: predominance of descriptive studies, inadequate evaluation of the exposure due to difficulties in the monitoring of pollutants, or estimates by dispersion models of uncertain accuracy and statistical evaluation with a weak epidemiological component (a mainly bivariate anlysis without control of possible confounding factors). A selection of ERFs is proposed for mortality and morbidity for its preliminary use in health impact evaluations, previous foundation of its aptitude.