[Evaluation of clinical competence in the postgraduate family medicine course, by means of the Structured Objective Clinical Test]. / Evaluación de la competencia clínica en el posgrado de medicina familiar mediante el Examen Clínico Objetivo Estructurado.

OBJECTIVE: To evaluate the clinical competence of first-year residents on the course specialising in family medicine, by applying a structured objective clinical test (SOCT) for simultaneous assessment of cognitive, affective and psychomotor areas. DESIGN: Observational and descriptive. SETTING: Family medicine clinics in the metropolitan area of Mexico City.Participants. 89 doctors on the specialist course in Family Medicine at the Autonomous University of Mexico (UNAM). MAIN MEASUREMENTS: After prior design of comparison lists, expert validation of content, and design of support material for the evaluation and pilot study, a SOCT with ten themes or sections, eight dynamic and two static, was administered. The cut-off point for competent performance was 60 out of 100, both in each section and in the overall average. The statistical analysis was univariate, using descriptive statistics. RESULTS: The overall average of scores in all sections was under 60. The highest average was 73, in the section for monitoring healthy children. In the five highest-scoring sections, the scattering was lower than in the other five. There were low scores in the family study section. CONCLUSIONS: Academic performance, as evaluated by a SOCT measuring clinical competence, was low. This kind of test enabled clinical competence to be assessed more objectively. Interval evaluation scales need to be tested so as to evaluate better the quality of the performance of clinical activities.

[Construct validity of FACES III questionnaire in Spanish (México)]. / Validez de constructo del cuestionario FACES III en español (México).

OBJECTIVE: To determine the construct validity of FACES III in spanish (México). DESIGN: Cross-sectional study, descriptive, confirmatory. SETTING: Mexico City, South of Federal District, Tlalpan area, divided into geo- statistical zones of a primary care unit. PATIENTS AND OTHER PARTICIPANTS: A random sample of 270 families selected in their dwellings with proportional coverage based on 17 895 dwellings of the influence area. Measurements and main results. Domicile survey applying FACES III (Family Adaptability and Cohesion Evaluation Scales) in spanish, México. Twelve criteria for evaluate the construct validity of FACES III trough confirmatory factor analysis were established by the researchers. Eight criteria were surpassing appropriately and four do not surpass the minimum values established. CONCLUSIONS: FACES III in spanish (México) is an instrument with reliability of 70% with Cronbach alfa and validity measured using confirmatory Factor Analysis. Nevertheless, we found four limitations that should be analyzed and evaluated in the planning of future studies.

[A reliability analysis of FACES III (the version in Spanish). Family Adaptability and Cohesion Evaluation Scales]. / Análisis de la confiabilidad de FACES III (versión en español).

OBJECTIVE: To determine through five methods (Cronbach's alpha, split, Guttman method, parallel and strict parallel) the confidence coefficient of FACES III, instrument validated on spanish version, and to evaluate it's consistency with these five statistical methods. DESIGN: Descriptive, cross-sectional. SETTING: Tlalpan Area, south of Federal District, México, divided into geo-statistical zones. PATIENTS AND OTHER PARTICIPANTS: A randomised sample of 270 dwellings with proportional coverage, based on 17,895 ordinary dwellings of the area. INTERVENTION: Domicile survey using FACES III (Family Adaptability and Cohesion Evaluation Scales); April-May 1995. MEASUREMENTS AND MAIN RESULTS: The confidence coefficient of FACES III spanish version was calculated using no standardised Cronbach's Alpha = 0.69; split I = 0.73 and split II = 0.66; Guttman method = 0.75; parallel = 0.69 and strict parallel = 0.53. CONCLUSIONS: Cronbach's coefficient demonstrated more advantages than the other statistical methods in relation with the ordinal measurement scale of FACES III. We suggest to take into consideration three important aspects for the correct confidence analysis of this kind of instruments: Variance analysis depending on the scale of items (F test, Friedman or Cochran) Inter-items interactions analysis (nonadditivity) and the use of the balance value as purge element of error' source. Analysis of Tukey estimate, coefficient of concordance (W) and Hotelling's T squared. It's necessary the evaluation and analysis of this aspects before the report of confidence's coefficient values whose can have hidden skew.

[Vaginal candidiasis: diagnosis and treatment in a primary care clinic]. / Candidiasis vaginal: diagnóstico y tratamiento en el primer nivel de atención médica.

OBJECTIVE: To assess the frequency of Candida species others than Candida albicans isolation, in patients with chronic as well as relapsing vaginitis. To analyze the clinical pictures and the treatments routinely employed in patients with Candida albicans infection, compared to those with other Candida species infection, in a Primary Care Clinic. DESIGN: Prospective, comparative, transverse study. SETTING: Primary health center from January, 1995 to May, 1997. MATERIAL: Two hundred and thirty four women (234) in ages between 16 and 55 years, with cervicovaginitis and a positive culture to any species of Candida, were the subject of the present study. RESULTS: From the total of 234 patients studied, 142 (60.5%) were infected by Candida albicans and 92 (39.5%) by other Candida species; no difference in symptomatology was recorded in both groups. Nistatine alone or combined with imidazole derivatives were the antimycotics more commonly employed, with Candida albicans resistance of 9.6% in the first case and 11.2% in the second one. CONCLUSIONS: It is stressed the importance that has the identification of Candida species causing vaginitis. It is also acknowledged the well handled treatment, despite of the species to be treated.

[Social determinants of family cohesion and adaptability]. / Determinantes sociales en la cohesión y adaptabilidad familiar.

OBJECTIVE: Evaluation of social determinants which are characteristics of balanced (functional) and extreme (dysfunctional) families regarding cohesion and flexibility dimensions. DESIGN: Observational, randomised survey. SETTING: Dr. José Castro Villagrana Primary Care Centre, Health Ministry, Mexico. PATIENTS: 270 randomised families of Tlalpan, Mexico City, who answered FACES III. MEASUREMENTS AND RESULTS: Using discriminant analysis statistical technique, 15 independent variables (social, demographic and familiar determinants) and two dependent variables (balanced and extreme types of families) were analysed and related with cohesion and adaptability dimensions. CONCLUSION: There is accordance of these results with others which were obtained using different family assessment instruments like Family Apgar. However using FACES III and Circumplex Model the analysis of variable's interaction were possible.

[Diagnosing community health by factorial analysis]. / Diagnóstico de salud comunitaria a través del análisis factorial.

OBJECTIVE: To identify the needs of medical care and to determine priorities in the delivery of health services by the factorial analysis of the health indicators obtained from study of the demographic, economic and family features of those registered at a Primary Care Centre. DESIGN: Descriptive and crossover. SETTING: Tlalpan area, Federal District, Mexico, divided into geo-statistical zones. Patients and other participants. A randomised sample of 590 dwellings, with proportional coverage, based on 173,000 inhabitants and 17,895 ordinary dwellings. INTERVENTION: Survey conducted in the home (April-July, 1993). MEASUREMENTS AND MAIN RESULTS: 16 health markers were classified into four categories, demographic, social, health-damaging and family. Nine markers with a reading on the Pearson's correlation index over 0.40 were chosen. Factorial analysis determined two main factors. CONCLUSIONS: The identification of the main risk factors by means of factorial analysis helped in diagnosing community health. A project needs to be worked out to define a methodology for studying medically dysfunctional families and to introduce a prevention and early diagnosis programme for Diabetes Mellitus.

[Knowledge and attitudes of female health workers regarding a program for the early detection of cervico-uterine cancer]. / Conocimientos y actitudes de trabajadoras de salud en torno al programa de detección oportuna de cáncer cérvico-uterino.

OBJECTIVE: To ascertain the degree of knowledge and general attitudes toward uterocervical carcinoma and the early cancer detection programme among female healthcare workers. DESIGN: Crossover descriptive study. Questionnaire to assess knowledge and general attitudes. SETTING: Primary health care centre (between April and June, 1995). PATIENTS: 55 sexually active female healthcare workers. RESULTS: Pertaining to knowledge, results showed an average of 8 +/- 4 correct answers, which correspond to a very low degree on a scale of 0 to 24 points; however, evaluation of general attitudes reflected a marked improvement, with an average response of 38 +/- 7 correct answer on a scale of 24 to 48 points. Single or married female doctors under 30, who started their sexual activity after 20 years of age, currently with 3 children or less, and professional experience with uterocervical carcinoma, had a more positive attitude and deeper understanding of this disease and the detection programme. CONCLUSIONS: Any successful educational programme on uterocervical carcinoma and early cancer detection, involves the promotion of knowledge and positive attitudes among female healthcare workers.

Biotypes of Gardnerella vaginalis isolated from urinary tract.

A modified scheme is proposed for biotyping Gardnerella vaginalis isolated from urinary tract of symptomatic and asymptomatic women based on detection of hippurate hydrolysis, beta-galactosidase (ONPG) and lipase, and fermentation of arabinose, galactose and xylose. Thirty biotypes were found among 73 strains. The distribution of biotypes was similar in both populations but the biotypes 1H, 5G and 7G were found more frequently in women without symptoms of urinary tract infection.

[Frequency of isolation of Ureaplasma urealyticum in an open population from southern Mexico City]. / Frecuencia de aislamiento de Ureaplasma urealyticum en una población abierta del sur de la ciudad de México.

Vaginal cultures for Ureaplasma urealyticum and confidential questionnaires were obtained from women with signs and symptoms of vaginitis who consulted a physician at a Primary Health Center, Tlalpan, D.F., México. In all 220 women were studied, 50 (22.7%) of whom were colonized with Ureaplasma urealyticum, statistical analysis (X2) showed there was no association between colonization with Ureaplasma urealyticum, and age, pregnancy, and other but there was association between colonization with Ureaplasma urealyticum and the number of pregnancies and no birth control method use.

[Gardnerella vaginalis biotypes: modification of a proposed system]. / Biotipos de Gardnerella vaginalis: modificación de un sistema propuesto.

A modified scheme is proposed for biotyping Gardnerella vaginalis based on detection of hippurate hydrolysis, beta-galactosidase (ONPG) and lipase, and fermentation of arabinose, galactose and xylose. Thirty three biotypes were found among 140 strains from women with and without bacterial vaginosis (non-specific vaginitis). The distribution of biotypes were found to be significantly different, being more predominant the biotypes 1A; 5G; 7A; 7D and 7G in women with vaginosis and the biotypes 5G and 6H in women without vaginosis. These data suggest that some biotypes of Gardnerella vaginalis are associated with bacterial vaginosis.