Prevalencia de disfunción sexual en gestantes en control prenatal en una institución hospitalaria en Rionegro, Colombia, 2020-2021 / Prevalence of sexual dysfunction among pregnant women attending prenatal care at a hospital in Rionegro, Colombia, 2020-2021

RESUMEN Objetivo: Describir la prevalencia de la disfunción sexual en un grupo de mujeres gestantes y hacer una exploración de posibles factores asociados a la disfunción sexual en estas mujeres. Materiales y métodos: Estudio descriptivo y trasversal en mujeres gestantes cuyas edades son de 15 años o más, con actividad sexual en la gestación, que asistieron al control prenatal en el Hospital San Juan de Dios de Rionegro entre los meses de enero y marzo del 2021. Se excluyeron pacientes con limitaciones o discapacidad cognitiva, o clasificadas con trastorno mental según la Organización Mundial de la Salud (OMS), gestantes con patologías crónicas, placentarias, ovulares, hemorrágicas e infecciosas, y las pacientes cuya gestación fue resultado de violencia sexual. Se aplicó el cuestionario Índice de Función Sexual Femenina (FSFI), se midieron variables sociodemográficas y de salud sexual y reproductiva. Los resultados se expresan en frecuencias absolutas y relativas para las variables cualitativas y medianas, y rangos intercuartílicos para las variables cuantitativas. Resultados: La mediana de edad fue de 27,5 años (RIC: 21,3-31,0); de edad gestacional 28,5 semanas (RIC: 21,3-34,8). Tras la aplicación del FSFI, 37 mujeres (37,7%) tuvieron disfunción sexual (puntaje < 26,5). La mediana del puntaje de las participantes sin disfunción sexual fue de 29,4 (RIC 26,8-32), mientras que por el lado de las que tienen disfunción sexual fue de 22,3 (RIC 20-24). La media del puntaje para cada dominio fue: deseo: 3,6 (RIC: 3,0-4,2); excitación: 4,5 (RIC: 3,6-5,1); lubricación: 4,8 (RIC: 3,9-5,4); orgasmo: 4,4 (RIC: 3,6-5,2); dolor: 4,4 (RIC: 3,6-6,0); y satisfacción: 5,4 (RIC: 4,8-6,0). Fueron factores protectores no tener hijos ni cesáreas previas. La ausencia de compañero y menor edad estuvieron asociados a disfunción sexual. Conclusión: La disfunción sexual se presenta en por lo menos un tercio de las gestantes, especialmente en el tercer trimestre. En la práctica clínica diaria se hace necesario abordar la disfunción sexual, ya que se puede contribuir desde el abordaje de la educación a un problema que puede afectar las relaciones de pareja y la calidad de vida. Es fundamental generar nuevas investigaciones que incluyan la evaluación de la efectividad y seguridad de estrategias educativas en este grupo poblacional con disfunción sexual.

ABSTRACT Objective: To describe the prevalence of sexual dysfunction in a group of pregnant women, and to explore potential factors associated with this condition in this population. Material and methods: Descriptive cross-sectional study in pregnant women 15 years of age and older, sexually active during gestation, receiving prenatal care at the San Juan de Dios Hospital in Rionegro between January and March, 2021. The exclusion criteria were patients with disabilities or cognitive impairment, or classified as having a mental disorder according to the World Health Organization (WHO); pregnant women with chronic, placental, ovulation, hemorrhagic or infectious conditions; and patients whose pregnancy was the result of sexual assault. The Female Sexual Function Index (FSFI) questionnaire was applied, and sociodemographic and sexual and reproductive health variables were measured. Results are expressed as absolute and relative frequencies for qualitative variables, and as medians and interquartile ranges for quantitative variables. Results: The mean age in years was 27.5 (IQR: 21.331.0) and the mean gestational age was 28.5 weeks (IQR: 21.3-34.8). After administering the FSFI, it was found that 37 women (37.7%) had sexual dysfunction (score < 26.5). The median scores for the participants without sexual dysfunction and those with sexual dysfunction were 29.4 (IQR 26.8-32) and 22.3 (IQR 20-24), respectively. The mean scores for each domain were: desire 3.6 (IQR: 3.0-4.2); arousal 4.5 (IQR: 3.65.1); lubrication 4.8 (IQR: 3.9-5.4); orgasm 4.4 (IQR: 3.6-5.2); pain 4.4 (IQR: 3.6-6.0); and satisfaction 5.4 (IQR: 4.8-6.0). The total score (p<0.05) was better in older women and those with one or more children. Conclusion: Sexual dysfunction occurs at least in one-third of pregnant women, especially during the third trimester. Sexual dysfunction should be considered in daily clinical practice, given that approaching the topic from an education perspective can help reduce a problem that affects the couple and quality of life. It is critical to undertake additional research that includes assessment of the effectiveness and safety of educational strategies in this population with sexual dysfunction.

Evolutionary drivers of the hump-shaped latitudinal gradient of benthic polychaete species richness along the Southeastern Pacific coast.

Latitudinal diversity gradients (LDG) and their explanatory factors are among the most challenging topics in macroecology and biogeography. Despite of its apparent generality, a growing body of evidence shows that 'anomalous' LDG (i.e., inverse or hump-shaped trends) are common among marine organisms along the Southeastern Pacific (SEP) coast. Here, we evaluate the shape of the LDG of marine benthic polychaetes and its underlying causes using a dataset of 643 species inhabiting the continental shelf (<200 m depth), using latitudinal bands with a spatial resolution of 0.5°, along the SEP (3-56° S). The explanatory value of six oceanographic (Sea Surface Temperature (SST), SST range, salinity, salinity range, primary productivity and shelf area), and one macroecological proxy (median latitudinal range of species) were assessed using a random forest model. The taxonomic structure was used to estimate the degree of niche conservatism of predictor variables and to estimate latitudinal trends in phylogenetic diversity, based on three indices (phylogenetic richness (PDSES), mean pairwise distance (MPDSES), and variation of pairwise distances (VPD)). The LDG exhibits a hump-shaped trend, with a maximum peak of species richness at ca. 42° S, declining towards northern and southern areas of SEP. The latitudinal pattern was also evident in local samples controlled by sampling effort. The random forest model had a high accuracy (pseudo-r2 = 0.95) and showed that the LDG could be explained by four variables (median latitudinal range, SST, salinity, and SST range), yet the functional relationship between species richness and these predictors was variable. A significant degree of phylogenetic conservatism was detected for the median latitudinal range and SST. PDSES increased toward the southern region, whereas VPD showed the opposite trend, both statistically significant. MPDSES has the same trend as PDSES, but it is not significant. Our results reinforce the idea that the south Chile fjord area, particularly the Chiloé region, was likely the evolutionary source of new species of marine polychaetes along SEP, creating a hotspot of diversity. Therefore, in the same way as the canonical LDG shows a decline in diversity while moving away from the tropics; on this case the decline occurs while moving away from Chiloé Island. These results, coupled with a strong phylogenetic signal of the main predictor variables suggest that processes operating mainly at evolutionary timescales govern the LDG.

Prevalence of sexual dysfunction among pregnant women attending prenatal care at a hospital in Rionegro, Colombia, 2020-2021 / Prevalencia de disfunción sexual en gestantes en control prenatal en una institución hospitalaria en Rionegro, Colombia, 2020-2021

Objective: To describe the prevalence of sexual dysfunction in a group of pregnant women, and to explore potential factors associated with this condition in this population. Material and methods: Descriptive cross-sectional study in pregnant women 15 years of age and older, sexually active during gestation, receiving prenatal care at the San Juan de Dios Hospital in Rionegro between January and March, 2021. The exclusion criteria were patients with disabilities or cognitive impairment, or classified as having a mental disorder according to the World Health Organization (WHO); pregnant women with chronic, placental, ovulation, hemorrhagic or infectious conditions; and patients whose pregnancy was the result of sexual assault. The Female Sexual Function Index (FSFI) questionnaire was applied, and sociodemographic and sexual and reproductive health variables were measured. Results are expressed as absolute and relative frequencies for qualitative variables, and as medians and interquartile ranges for quantitative variables. Results: The mean age in years was 27.5 (IQR: 21.3-31.0) and the mean gestational age was 28.5 weeks (IQR: 21.3-34.8). After administering the FSFI, it was found that 37 women (37.7%) had sexual dysfunction (score < 26.5). The median scores for the participants without sexual dysfunction and those with sexual dysfunction were 29.4 (IQR 26.8-32) and 22.3 (IQR 20-24), respectively. The mean scores for each domain were: desire 3.6 (IQR: 3.0-4.2); arousal 4.5 (IQR: 3.6-5.1); lubrication 4.8 (IQR: 3.9-5.4); orgasm 4.4 (IQR: 3.6-5.2); pain 4.4 (IQR: 3.6-6.0); and satisfaction 5.4 (IQR: 4.8-6.0). The total score (p<0.05) was better in older women and those with one or more children. Conclusion: Sexual dysfunction occurs at least in one third of pregnant women, especially during the third trimester. Sexual dysfunction should be considered in daily clinical practice, given that approaching the topic from an education perspective can help reduce a problem that affects the couple and quality of life. It is critical to undertake additional research that includes assessment of the effectiveness and safety of educational strategies in this population with sexual dysfunction.

Objetivo: describir la prevalencia de la disfunción sexual en un grupo de mujeres gestantes y hacer una exploración de posibles factores asociados a la disfunción sexual en estas mujeres. Materiales y métodos: estudio descriptivo y trasversal en mujeres gestantes cuyas edades son de 15 años o más, con actividad sexual en la gestación, que asistieron al control prenatal en el Hospital San Juan de Dios de Rionegro entre los meses de enero y marzo del 2021. Se excluyeron pacientes con limitaciones o discapacidad cognitiva, o clasificadas con trastorno mental según la Organización Mundial de la Salud (OMS), gestantes con patologías crónicas, placentarias, ovulares, hemorrágicas e infecciosas, y las pacientes cuya gestación fue resultado de violencia sexual. Se aplicó el cuestionario Índice de Función Sexual Femenina (FSFI), se midieron variables sociodemográficas y de salud sexual y reproductiva. Los resultados se expresan en frecuencias absolutas y relativas para las variables cualitativas y medianas, y rangos intercuartílicos para las variables cuantitativas. Resultados: la mediana de edad fue de 27,5 años (RIC: 21,3-31,0); de edad gestacional 28,5 semanas (RIC: 21,3-34,8). Tras la aplicación del FSFI, 37 mujeres (37,7%) tuvieron disfunción sexual (puntaje < 26,5). La mediana del puntaje de las participantes sin disfunción sexual fue de 29,4 (RIC 26,8-32), mientras que por el lado de las que tienen disfunción sexual fue de 22,3 (RIC 20-24). La media del puntaje para cada dominio fue: deseo: 3,6 (RIC: 3,0-4,2); excitación: 4,5 (RIC: 3,6-5,1); lubricación: 4,8 (RIC: 3,9-5,4); orgasmo: 4,4 (RIC: 3,6-5,2); dolor: 4,4 (RIC: 3,6-6,0); y satisfacción: 5,4 (RIC: 4,8-6,0). Fueron factores protectores no tener hijos ni cesáreas previas. La ausencia de compañero y menor edad estuvieron asociados a disfunción sexual. Conclusión: la disfunción sexual se presenta en por lo menos un tercio de las gestantes, especialmente en el tercer trimestre. En la práctica clínica diaria se hace necesario abordar la disfunción sexual, ya que se puede contribuir desde el abordaje de la educación a un problema que puede afectar las relaciones de pareja y la calidad de vida. Es fundamental generar nuevas investigaciones que incluyan la evaluación de la efectividad y seguridad de estrategias educativas en este grupo poblacional con disfunción sexual.

Morphological, technological and nutritional properties of flours and starches from mashua (Tropaeolum tuberosum) and melloco (Ullucus tuberosus) cultivated in Ecuador.

Morphological, technological and nutritional analyses were done in two scarcely studied starches from Andean tubers (mashua and melloco). The low sedimentation values, and the high zeta potential of mashua and melloco starches in cold dispersions, as consequence of their electronegativity, indicated a better behaviour as stabilizer than potato starch. During heating, mashua and melloco starches presented much higher viscosity than potato starch, associated with their higher average particle size and greater amylose content. DSC and TGA analyses indicated that melloco starch had the highest gelatinization enthalpy ΔHgel (12.32 J g-1) and degradation temperature (270 °C), in comparison with potato starch, which are indicators of a better thermal resistance. Consequently, extracted mashua and melloco starches could be excellent and cost-effective thickening or gelling agents in both foods and a wide range of biomaterials. Mashua and melloco starches exhibited a digestion rate close to 80%, which agreed with the low resistant starch content.

Antegrade Posterior Interosseous Flap for Nonhealing Wounds of the Elbow: Anatomical and Clinical Study.

BACKGROUND: The posterior interosseous artery (PIA) flap has been widely reported to cover defects at the dorsal aspect of the hand. However, the use of this flap to cover elbow defects has been rarely reported. The purpose of this study was to analyze the anatomical feasibility of the PIA flap to cover elbow soft-tissue defects and, additionally, to review the clinical outcomes of patients treated with this flap. METHODS: An anatomical study was performed on 14 cadaveric specimens to assess the number of PIA perforators at the distal third of the forearm, along with the distance of the perforators from the ulnar styloid. Additionally, the pedicle distance from the pivot point to the lateral epicondyle was recorded. A clinical study in 4 patients with elbow soft-tissue defects treated with the antegrade PIA was also performed to assess viability and clinical outcomes. RESULTS: A mean of 3 perforators (range, 2-4) of the PIA were found in the distal third of the forearm. The pedicle distance from the pivot point to the lateral epicondyle was 10 cm (range, 8-11.5 cm). In the clinical study, all cases treated with the antegrade PIA flap showed satisfactory outcomes without loss of the flap or significant partial necrosis. CONCLUSION: In this limited series, the antegrade PIA flap has shown to be a reliable and effective alternative for treatment of soft-tissue defects at the elbow. The PIA perforators in the distal forearm and the pedicle length allow the flap to easily reach the elbow.

Planning low-carbon electricity systems under uncertainty considering operational flexibility and smart grid technologies.

Electricity grid operators and planners need to deal with both the rapidly increasing integration of renewables and an unprecedented level of uncertainty that originates from unknown generation outputs, changing commercial and regulatory frameworks aimed to foster low-carbon technologies, the evolving availability of market information on feasibility and costs of various technologies, etc. In this context, there is a significant risk of locking-in to inefficient investment planning solutions determined by current deterministic engineering practices that neither capture uncertainty nor represent the actual operation of the planned infrastructure under high penetration of renewables. We therefore present an alternative optimization framework to plan electricity grids that deals with uncertain scenarios and represents increased operational details. The presented framework is able to model the effects of an array of flexible, smart grid technologies that can efficiently displace the need for conventional solutions. We then argue, and demonstrate via the proposed framework and an illustrative example, that proper modelling of uncertainty and operational constraints in planning is key to valuing operationally flexible solutions leading to optimal investment in a smart grid context. Finally, we review the most used practices in power system planning under uncertainty, highlight the challenges of incorporating operational aspects and advocate the need for new and computationally effective optimization tools to properly value the benefits of flexible, smart grid solutions in planning. Such tools are essential to accelerate the development of a low-carbon energy system and investment in the most appropriate portfolio of renewable energy sources and complementary enabling smart technologies.This article is part of the themed issue 'Energy management: flexibility, risk and optimization'.

Distribution, genetic diversity and potential spatiotemporal scale of alien gene flow in crop wild relatives of rice (Oryza spp.) in Colombia.

BACKGROUND: Crop wild relatives (CWRs) of rice hold important traits that can contribute to enhancing the ability of cultivated rice (Oryza sativa and O. glaberrima) to produce higher yields, cope with the effects of climate change, and resist attacks of pests and diseases, among others. However, the genetic resources of these species remain dramatically understudied, putting at risk their future availability from in situ and ex situ sources. Here we assess the distribution of genetic diversity of the four rice CWRs known to occur in Colombia (O. glumaepatula, O. alta, O. grandiglumis, and O. latifolia). Furthermore, we estimated the degree of overlap between areas with suitable habitat for cultivated and wild rice, both under current and predicted future climate conditions to assess the potential spatiotemporal scale of potential gene flow from GM rice to its CWRs. RESULTS: Our findings suggest that part of the observed genetic diversity and structure, at least of the most exhaustively sampled species, may be explained by their glacial and post-glacial range dynamics. Furthermore, in assessing the expected impact of climate change and the potential spatiotemporal scale of gene flow between populations of CWRs and GM rice we find significant overlap between present and future suitable areas for cultivated rice and its four CWRs. Climate change is expected to have relatively limited negative effects on the rice CWRs, with three species showing opportunities to expand their distribution ranges in the future. CONCLUSIONS: Given (i) the sparse presence of CWR populations in protected areas (ii) the strong suitability overlap between cultivated rice and its four CWRs; and (iii) the complexity of managing and regulating areas to prevent alien gene flow, the first priority should be to establish representative ex situ collections for all CWR species, which currently do not exist. In the absence of studies under field conditions on the scale and extent of gene flow between cultivated rice and its Colombian CWRs, effective in situ conservation might best be achieved through tailor-made management plans and exclusion of GM rice cultivation in areas holding the most genetically diverse CWR populations. This may be combined with assisted migration of populations to suitable areas where rice is unlikely to be cultivated under current and future climate conditions.

Espondilodiscitis cervical por Streptococcus agalactiae y síndrome de Parsonage-Turner secundario / Cervical spondylodiscitis caused by Streptococcus agalactiae and Parsonage-Turner syndrome

La espondilodiscitis por Streptococcus agalactiae es infrecuente, ya que éste es un microrganismo clásicamente patógeno en el periodo gestacional y perinatal. Sin embargo se está produciendo un aumento en la incidencia de infecciones invasivas en adultos inmunocompetentes. Asimismo, el síndrome de Parsonage-Turner o neuritis braquial aguda es una entidad clínica poco frecuente, caracterizada por dolor y debilidad muscular de la extremidad superior. Presentamos el caso de un varón de 50 años con bacteriemia por S. agalactiae, espondilodiscitis cervical y neuritis braquial secundaria y revisamos la literatura.

Spondylodiscitis caused by streptococcus agalactiae has been traditionally considered an infrequent disease since S. agalactiae is a pathogenic microorganism conventionally in gestational and perinatal period. However it is producing an increase in the incidence of invasive infections in immunocompetent adults. Also Parsonage-Turner syndrome or brachial radiculitis is a rare disorder and is characterized by pain followed by weakness in the distribution of the upper brachial plexus. We report one case and review the literature.

[Perception of medical students about formative assessments during clinical courses]. / Utilidad de la evaluación formativa en cursos clínicos integrativos en estudiantes de pregrado de medicina.

BACKGROUND: Formative evaluation is a range of formal assessment employed by professors during the teaching process in order to modify curriculum activities, to improve student attainment. For students, it is helpful to evaluate their learning process. Although recommended, it is seldom used. AIM: To evaluate the perception and performance of medical students subjected to formative assessments during an integrative clinical course. MATERIAL AND METHODS: Fourth year medical students that participated in a multiple choice formative assessment, similar to the final exam during 2007 and 2008, responded a survey about the usefulness and quality of such assessment. Student achievement was expressed as the percentage of correct answers of the tests. RESULTS: The formative assessment was answered by 99% of students. In 2007 97% of students considered the experience as excellent or very good and 92% evaluated it as useful or very useful. During 2008 the figures were 89% and 79%. The students outlined that this assessment oriented their study, allowed them to discover their weaknesses and have a perception of the degree of difficulty of the final exam. Over 90% of students that took the formative evaluation, improved their academic achievement. CONCLUSIONS: Formative assessments are well evaluated by medical students and improve their academic achievement.

Utilidad de la evaluación formativa en cursos clínicos integrativos en estudiantes de pregrado de medicina / Perception of medical students about formative assessments during clinical courses

Background: Formative evaluation is a range of formal assessment employed by professors during the teaching process in order to modify curriculum activities, to improve student attainment. For students, it is helpful to evaluate their learning process. Although recommended, it is seldom used. Aim: To evaluate the perception and performance of medical students subjected to formative assessments during an integrative clinical course. Material and Methods: Fourth year medical students that participated in a multiple choice formative assessment, similar to the final exam during 2007 and 2008, responded a survey about the usefulness and quality of such assessment. Student achievement was expressed as the percentage of correct answers of the tests. Results: The formative assessment was answered by 99% of students. In 2007 97% of students considered the experience as excellent or very good and 92% evaluated it as useful or very useful. During 2008 the figures were 89% and 79%. The students outlined that this assessment oriented their study, allowed them to discover their weaknesses and have a perception of the degree of difficulty of the final exam. Over 90% of students that took the formative evaluation, improved their academic achievement. Conclusions: Formative assessments are well evaluated by medical students and improve their academic achievement.

[Etiology of pneumonia in chilean HIV-infected adult patients]. / Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana.

OBJECTIVES: To establish the etiology of pneumonia and to compare the yield of diagnostic techniques for diagnosis of Pneumocystis jiroveci and Mycobacterium tuberculosis infections in HIV-1-infected patients. PATIENTS AND METHODS: Subjects underwent sputum induction and bronchoalveolar lavage (BAL). Gram, Ziehl-Neelsen, silver stain (SS) and immunofluorescense staining (IF) for P. jiroveci, fluorescent stain for mycobacteria, PCR for P. jiroveci and M. tuberculosis, aerobic, fungal and mycobacterial cultures, respiratory viruses and CMV cultures were performed on the sputum and BAL. IgM for Mycoplasma pneumoniae and Chlamydophyla pneumoniae, and Legionella pneumophila urinary antigen were also obtained. RESULTS: Sixty patients were included. An etiologic diagnosis was made in 97%. Pneumocystis jiroveci was the most frequent etiology (58%) followed by Streptococcus pneumoniae (12%), and Mycobacterium avium complex (12%). Mycobacterium tuberculosis was found in 5%. CONCLUSIONS: The comparison of diagnostic methods for P. jiroveci showed a higher sensitivity of IF and SS in BAL than in sputum, however PCR was equally sensitive in both samples. With this approach a precise etiologic diagnosis was reached in the great majority of patients. The most common etiology was P. jiroveci. IF in BAL remains the gold standard for diagnosis of P. jiroveci pneumonia.

Paradigmas sobre el diagnóstico, abordaje y tratamiento de la problemática drogadictiva / Paradigms about the diagnosis, management and treatment of the problem drogadictiva

El objetivo central del presente trabajo de investigación consistió en conocer, mediante entrevistas semiestructuradas los paradigmas que los psicólogos que trabajaron en el campo de la drogadependencia tienen sobre el diagnóstico, abordaje y tratamiento de las problemáticas drogadictivas. Este trabajo se encuadro dentro de los estudios de tipo exploratorio. Se realizó en primer lugar un rastreo teórico bibliográfico sobre la clínica psicológica de la drogadicción mas un trabajo de campo, con los resultados de ambos se buscó similitudes y diferencias para conocer e inferir los paradigmas pretendidos. En el análisis se encontró con que la multifactorialidad está siempre presente tanto a la hora de diagnosticar como de tratar la problemática, se planteó que el trabajo grupal y la abstinencia son elementos importantes en el tratamiento pero no fundamentales ni centrales y quedo en claro que para resolver una problemática ligada al consumo de sustancia hay que ir mas allá de la simple relación con la sustancia para abordar y trabajar sobre la trama subjetiva subyacente a ese hábito toxico.

The main objective of this research was to determine, through semi-structured interviews paradigms that psychologists working in the field of drug dependency have on the diagnosis, management and treatment of problematic addicts. This work forms part of exploratory studies. We performed first a theoretical scan of the literature on the psychological clinic of the drug over a field, with the results of both similarities and differences to understand and infer the intended paradigms. The analysis found that the multifactorial nature is always present both in the diagnosis and to treat the problem. It was suggested that the group work and abstinence are important but not central elements in the basic treatment and it was clear that solve a problem linked to substance abuse should go beyond the simple relationship with the substance to address and work on the plot underlying subjective toxic habit.

[An instrument in Spanish to evaluate the performance of clinical teachers by students]. / Desarrollo y validación de un instrumento en Español para evaluar el desempeño de docentes clínicos a través de las percepciones de sus estudiantes.

BACKGROUND: The modernization of clinical teaching has called for the creation of faculty development programs, and the design of suitable instruments to evaluate clinical teachers' performance. AIM: To report the development and validation of an instrument in Spanish designed to measure the students' perceptions of their clinical teachers' performance and to provide them with feedback to improve their teaching practices. MATERIAL AND METHODS: In a process that included the active participation of authorities, professors in charge of courses and internships, clinical teachers, students and medical education experts, we developed a 30-item questionnaire called MEDUC30 to evaluate the performance of clinical teachers by their students. The internal validity was assessed by factor analysis of 5214 evaluations of 265 teachers, gathered from 2004 to 2007. The reliability was measured with the Cronbach's alpha coefficient and the generalizability coefficient (g). RESULTS: MEDUC30 had good content and construct validity. Its internal structure was compatible with four factors: patient-centered teaching, teaching skills, assessment skills and learning climate, and it proved to be consistent with the structure anticipated by the theory. The scores were highly reliable (Cronbach's alpha: 0.97); five evaluations per teacher were sufficient to reach a reliability coefficient (g) of 0.8. CONCLUSIONS: MEDUC30 is a valid, reliable and useful instrument to evaluate the performance of clinical teachers. To our knowledge, this is the first instrument in Spanish for which solid validity and reliability evidences have been reported. We hope that MEDUC30 will be used to improve medical education in Spanish-speaking medical schools, providing teachers a specific feedback upon which to improve their pedagogical practice, and authorities with valuable information for the assessment of their faculty.

Desarrollo y validación de un instrumento en Español para evaluar el desempeño de docentes clínicos a través de las percepciones de sus estudiantes / An instrument in Spanish to evaluate the performance of clinical teachers by students

Background: The modernization of clinical teaching has called for the creation of faculty development programs, and the design of suitable instruments to evaluate clinical teachers’ performance. Aim: To report the development and validation of an instrument in Spanish designed to measure the students’ perceptions of their clinical teachers’ performance and to provide them with feedback to improve their teaching practices. Material and Methods: In a process that included the active participation of authorities, professors in charge of courses and internships, clinical teachers, students and medical education experts, we developed a 30-item questionnaire called MEDUC30 to evaluate the performance of clinical teachers by their students. The internal validity was assessed by factor analysis of 5,214 evaluations of 265 teachers, gathered from 2004 to 2007. The reliability was measured with the Cronbach’s alpha coefficient and the generalizability coefficient (g). Results: MEDUC30 had good content and construct validity. Its internal structure was compatible with four factors: patient-centered teaching, teaching skills, assessment skills and learning climate, and it proved to be consistent with the structure anticipated by the theory. The scores were highly reliable (Cronbach’s alpha: 0.97); five evaluations per teacher were sufficient to reach a reliability coefficient (g) of 0.8. Conclusions: MEDUC30 is a valid, reliable and useful instrument to evaluate the performance of clinical teachers. To our knowledge, this is the first instrument in Spanish for which solid validity and reliability evidences have been reported. We hope that MEDUC30 will be used to improve medical education in Spanish-speaking medical schools, providing teachers a specific feedback upon which to improve their pedagogical practice, and authorities with valuable information for the assessment of their faculty.

Measuring students' perceptions of the educational climate of the new curriculum at the Pontificia Universidad Católica de Chile: performance of the Spanish translation of the Dundee Ready Education Environment Measure (DREEM).

CONTEXT: During the last decade a major curriculum reform was carried out at the Pontificia Universidad Católica de Chile Medical School. The process included changes in curriculum development, staff development and in the infrastructure. However, it is not known how students perceived the climate of their education within the new model. OBJECTIVES: To measure students' perceptions of the educational environment of the new curriculum and to evaluate the internal consistency of the 50-item Dundee Ready Education Environment Measure (DREEM) Spanish version questionnaire. METHODS: The DREEM Spanish version questionnaire was administered to undergraduate medical students in training years 3, 4 and 5. Internal consistency of the instrument and its subscales were measured with the method described by Cronbach, and the results were expressed with alpha coefficient ranging from 0 to 1. FINDINGS: Responses were received from 297 out of 328 students (90.5%). The 50-item DREEM Spanish version was found highly reliable with an alpha coefficient of 0.91. The subscale with the highest mean score was "Academic Self-Perceptions", which indicates students' perceptions of their academic achievements. Mean score of this subscale was 22.3 +/- 4.1 corresponding to 69.7% of the maximum score. The lowest mean score was for the Students' Perceptions of their Social Environment: 15.9 +/- 4.0 (56.8%). The overall mean score for the 50 items was 127.5 +/- 20.9 (63.8% of maximum). Scores observed in students in year 5 were significantly lower for several subscales, including Students' Perceptions of Learning, Students' Perceptions of Teachers, Students' Perceptions of the Learning Atmosphere and Students' Perceptions of the Social Environment, and also lower for the overall mean score (119.3 +/- 20.2) compared to scores in years 3 and 4 (128.8 +/- 21 and 132.5 +/- 19.7, respectively; p<0.001). CONCLUSIONS: The school's educational climate was generally perceived positively by students, although they viewed the school's social environment less favorably. Specific areas identified by students as needing improvement included an overloaded curriculum and inadequate student supports. The DREEM Spanish version proved generally reliable, by internal consistency scores based on ratings by Chilean undergraduate medical students; it should be a useful tool for assessing students' perceptions of the educational environments of other Latin American medical schools.

[A workshop to improve written communication skills of medical students]. / Mejoría en las habilidades de comunicación escrita de estudiantes de medicina: Impacto de un taller de escritura.

BACKGROUND: Despite being among the best academically prepared of the country, many medical students have difficulties to communicate in writing. In 2005, the School of Medicine at the Pontificia Universidad Católica de Chile introduced a writing workshop in the undergraduate curriculum, to enhance the students' writing skills. AIM: To describe the workshop and its impact on the writing skills of 3 cohorts of students. MATERIAL AND METHODS: This 30-h workshop used a participative methodology with emphasis on deliberate practice and feedback. Students worked in small groups with a faculty member specially trained in writing. The qualities of the essays written before and after the workshop were compared. Essays were rated by a professional team that used an analytic rubric to measure formal aspects of text writing as well as more complex thinking processes. RESULTS: There was a significant improvement in the quality of the texts written after the workshop; the main changes occurred in argumentation, and in paragraph and text structure. This improvement was inversely proportional to the initial level of performance, and independent of gender. CONCLUSIONS: A writing workshop based on deliberate practice and personalized feedback is effective to enhance the writing proficiency of medical students. Due to its design, this workshop could be useful for students of other careers and universities.

Mejoría en las habilidades de comunicación escrita de estudiantes de medicina: impacto de un taller de escritura / A workshop to improve written communication skills of medical students

Background: Despite being among the best academically prepared of the country, many medical students have difficulties to communicate in writing. In 2005, the School of Medicine at the Pontificia Universidad Católica de Chile introduced a writing workshop in the undergraduate curriculum, to enhance the students' writing skills. Aim: To describe the workshop and its impact on the writing skills of 3 cohorts of students. Material and methods: This 30-h workshop used a participative methodology with emphasis on deliberate practice and feedback. Students worked in small groups with a faculty member specially trained in writing. The qualities of the essays written before and after the workshop were compared. Essays were rated by a professional team that used an analytic rubric to measure formal aspects of text writing as well as more complex thinking processes. Results: There was a significant improvement in the quality of the texts written after the workshop; the main changes occurred in argumentation, and in paragraph and text structure. This improvement was inversely proportional to the initial level of performance, and independent of gender Conclusions: A writing workshop based on deliberate practice and personalized feedback is effective to enhance the writing proficiency of medical students. Due to its design, this workshop could be useful for students of other careers and universities.

Rat and hamster species differences in susceptibility to elastase-induced pulmonary emphysema relate to differences in elastase inhibitory capacity.

Syrian Golden hamsters develop severe emphysema after a single intratracheal dose of elastase, whereas Sprague-Dawley rats exhibit mild emphysema with the same dose per kilogram body weight. We hypothesized that the development of severe emphysema is prevented in rats by the high serum level of alpha1-antitrypsin reported in rats, compared with hamsters, which provides for a high lung elastase inhibitory capacity (EIC). To explore this possibility, we challenged the antiprotease system of the rats by treating them with three similar weekly doses of elastase. Four months after treatment, we evaluated changes in histology, volume, and elastic properties of rat lungs and compared them with those of hamsters receiving a single dose of elastase. We also measured serum alpha1-antitrypsin levels and serum and lung EIC in control rats and hamsters. Results showed that, in association with 40% less serum and lung EIC compared with rats (P < 0.001), hamster lungs had upper-lobe bullae formation, severe microscopic emphysema, a fourfold increase in lung volume (P < 0.01) and a threefold increase in constant k, an index of compliance, of the lung deflation pressure-volume curve (P < 0.01). In contrast, rats developed mild emphysema, with only 50% increase in volume (P < 0.05) and 60% increase in constant k (P < 0.01). In conclusion, two species that differ in serum and lung EIC exhibit significant differences in emphysema development after elastase. Rats with high EIC, despite receiving three doses of elastase, showed significantly less derangement of morphological and physiological parameters than hamsters with low EIC receiving a single dose.

Análise anátomo-radiográfica da persistência do Forame de Huschke / Anatomic and radiograph study of the persistence of Foramen of Huschke

OBJETIVO: o objetivo neste trabalho é avaliar e localizar o Forame de Huschke. FORMA DE ESTUDO: anatômico. MATERIAL E MÉTODO: utilizando materiais de contraste como a Guta percha e o sulfato de bário, através de técnicas radiográficas extrabucais, como a panorâmica, submentovértex e a tomografia linear lateral corrigida para a Articulação Têmporo-mandibular, em quatro crânios, onde foi verificada clinicamente a presença do Forame de Huschke. RESULTADO: Os resultados obtidos mostraram que o Forame de Huschke pôde ser observado em crânios secos após a sua evidenciação por meio de material de contraste nestas técnicas radiográficas.

[High prevalence of Down syndrome in the Rancagua Hospital in central Chile]. / Alta prevalencia de síndrome de Down en el Hospital Regional Rancagua, Chile. Período 1997-2003.

BACKGROUND: The Latin American Collaborative Study for Congenital Malformations (ECLAMC) has detected a higher incidence of Down syndrome in a zone of central Chile than in the rest of the country. AIM: To analyze the incidence rates of Down syndrome between 1997 and 2003 at the Regional Hospital of Rancagua, located 90 km south of Santiago, Chile. MATERIAL AND METHODS: The information obtained by ECLAMC was used. This program, using a case control methodology, registers all newborns with congenital malformations and assigns, as a control, the next normal newborn of the same sex. RESULTS: During the study period, 106 newborns with Down syndrome were registered, with a mean rate of 29.61 per 10,000 live births, twice higher than expected. The rate variations along the years of study suggest a cyclic change, with a hemicycle of six years. CONCLUSIONS: In this hospital, mothers under 35 years of age, have twice the risk of having a child with Down syndrome, than in the rest of the country.