Desempeño de las escuelas de medicina en México: resultados del Examen Nacional para Aspirantes a Residencias Médicas / Performance of medical schools in Mexico: Results from the Examen Nacional para Aspirantes a Residencias Médicas

Resumen: Objetivo: Evaluar el desempeño de las facultades y escuelas de medicina (FEM) utilizando como subrogado los resultados del Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Material y métodos: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017, empleando cinco criterios de desempeño (CD) por cada FEM: dos oficiales y tres creados exprofeso. Resultados. En 2016 y 2017 se registraron sustentantes de 112 y 115 FEM, respectivamente. Dependiendo del CD, la FEM que quedó clasificada en el primer lugar obtuvo entre 5 y 20 puntos más que la del segundo lugar, y entre 23 y 98 puntos más que la FEM ubicada en el último lugar. Aproximadamente 25% de los sustentantes fueron calificados como "deficientes en conocimientos" y aproximadamente 80% de éstos provenían de menos de un tercio de las FEM. Conclusiones: El ENARM arroja información sobre el desempeño de las FEM. Aproximadamente uno de cada cuatro sustentantes obtuvo puntajes menores al aprobatorio en cualquier especialidad.

Abstract: Objective: To assess the performance of medical schools (FEM) by analyzing the results of their applicants in the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Materials and methods: Five performance criteria, two official and three created on purpose, were calculated from the ENARM-2016 and -2017 official databases to assess FEM performance. Results: In 2016 and 2017, applicants registered from 112 and 115 FEM, respectively. Depending on the performance criteria, the FEM in the first place obtained 5 to 20 points more than the one placed second, and 23 to 98 points more than the FEM in the last place. Approximately 25% applicants were classified as "knowledge-deficient," and about 80% of these originated from less than one third of the FEM. Conclusion: The ENARM results provide information on the performance of the FEM. Approximately one of every four applicants obtained scores lower than the approval threshold of any specialty.

[Performance of medical schools in Mexico: results from the Examen Nacional para Aspirantes a Residencias Médicas]. / Desempeño de las escuelas de medicina en México: resultados del Examen Nacional para Aspirantes a Residencias Médicas.

OBJECTIVE: To assess the performance of medical schools (FEM) by analyzing the results of their applicants in the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIALS AND METHODS: Five performance criteria, two official and three created on purpose, were calculated from the ENARM-2016 and -2017 official databases to assess FEM performance. RESULTS: In 2016 and 2017, applicants registered from 112 and 115 FEM, respectively. Depending on the performance criteria, the FEM in the first place obtained 5 to 20 points more than the one placed second, and 23 to 98 points more than the FEM in the last place. Approximately 25% applicants were classified as "knowledge-deficient," and about 80% of these originated from less than one third of the FEM. CONCLUSIONS: The ENARM results provide information on the performance of the FEM. Approximately one of every four applicants obtained scores lower than the approval threshold of any specialty.

OBJECTIVE: Evaluar el desempeño de las facultades y escuelas de medicina (FEM) utilizando como subrogado los resultados del Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIALS AND METHODS: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017, empleando cinco criterios de desempeño (CD) por cada FEM: dos oficiales y tres creados exprofeso. RESULTS: En 2016 y 2017 se registraron sustentantes de 112 y 115 FEM, respectivamente. Dependiendo del CD, la FEM que quedó clasificada en el primer lugar obtuvo entre 5 y 20 puntos más que la del segundo lugar, y entre 23 y 98 puntos más que la FEM ubicada en el último lugar. Aproximadamente 25% de los sustentantes fueron calificados como "deficientes en conocimientos" y aproximadamente 80% de éstos provenían de menos de un tercio de las FEM. CONCLUSIONS: El ENARM arroja información sobre el desempeño de las FEM. Aproximadamente uno de cada cuatro sustentantes obtuvo puntajes menores al aprobatorio en cualquier especialidad.

Prevalence of alexithymia in eating disorders in a clinical sample of 800 Mexican patients.

INTRODUCTION: The inability to identify, express feelings, and not distinguish between emotions and bodily sensations, is known as alexithymia. In 1988, it developed The Toronto Alexithymia Scale (TAS-20), consists of 20 items and three factors: a) difficulty of identifying feelings and differences between feelings and bodily sensations; b) difficulty of describing feelings; and c) externally oriented thinking. It's considered that people with eating disorders have specific deficits in identify and communicate their feelings. OBJECTIVE: The present study has as purpose to the instrument validation. METHODS: It was a cross-sectional study and psychometric character design of a single sample, formed of 435 persons suffering eating disorder (ED), with an age range of 12-68 years, of which 91% were women and 9% were men. To obtain the reliability of the instrument, applies internal consistency test, which resulted in an alpha of 0.89, then applied a factor analysis of principals components with oblimin rotation. RESULTS: According to statistical analysis, were eliminated six items, so the scale finished with 14 items, and to analyze it observed that these items correspond with the two main factors of the original scale. The ED patients present alexithymia. DISCUSSION: The scale satisfies the criteria of validity necessary for use in this population.

INTRODUCCIÓN: La incapacidad para identificar y expresar sentimientos, y no distinguir entre las emociones y las sensaciones corporales, se conoce como alexitimia. En 1988 se desarrolló la Escala de Alexitimia de Toronto (TAS-20), que está conformada por 20 reactivos y tres factores: a) dificultad para identificar los sentimientos y las diferencias entre sentimientos y sensaciones corporales; b) dificultad para describir sentimientos; y c) pensamiento orientado externamente. Se considera que las personas con trastornos de la conducta alimentaria (TCA) tienen déficits específicos en la identificación y la comunicación de sus sentimientos. OBJETIVO: Realizar la validación de dicho instrumento. MÉTODO: Estudio de tipo transversal y de carácter psicométrico con diseño de una sola muestra, conformada por 435 personas con diagnóstico de TCA, con un rango de edad de 12 a 68 años, de las cuales el 91% eran mujeres y el 9% eran hombres. Para obtener la confiabilidad del instrumento se aplicó una prueba de consistencia interna, que dio como resultado un alfa de 0.89; posteriormente se hizo un análisis factorial de componentes principales con rotación oblimin. RESULTADOS: De acuerdo con el análisis estadístico, se eliminaron seis reactivos, de tal forma que la escala finalizó con 14 reactivos, y al analizarlos se observó que concordaban con los dos factores principales de la escala original. Las pacientes con TCA presentan alexitimia. DISCUSIÓN: La escala satisface los criterios de validez necesarios para ser utilizada en dicha población.

Flaws in the design of the Examen Nacional para Aspirantes a Residencias Médicas produce inequity.

OBJECTIVE: To assess the assumption of 'equity' of Mexico's resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIALS AND METHODS: Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. RESULTS: There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). CONCLUSIONS: Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned.

OBJETIVO: Evaluar el atributo de "equidad" asignado al Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIAL Y MÉTODOS: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017. Se compararon las diferencias inter-día de respuestas correctas (regresión linear multivariable) y de sustentantes que alcanzaron el puntaje mínimo de su especialidad (PME) (razón de momios [RM]). Se estimó a los afectados por la inequidad. RESULTADOS: Hubo 36 114 sustentantes en 2016 y 38 380 en 2017.Los días 2 (ENARM-2016) y 1-2 (ENARM-2017) registraronpuntajes significativamente más altos, y más sustentantes alcanzaron el PME que en los días 1-3-4 (RM .55) y 5 (RM 3.8) en 2016, y los días 3-4 (RM 1.85) y 5 (RM 4.04) en 2017. Se estimó que cuatro de cada diez sustentantes que aprobaron el ENARM no lo hubieran hecho si el examen fuera equitativo. CONCLUSIONES: Los resultados sugieren que el atributo de equidad del ENARM está en duda.

Flaws in the design of the Examen Nacional para Aspirantes a Residencias Médicas produce inequity / Fallas en el diseño del Examen Nacional para Aspirantes a Residencias Médicas generan inequidad

Abstract: Objective: To assess the assumption of 'equity' of Mexico's resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Materials and methods: Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. Results: There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). Conclusion: Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned.

Resumen_ Objetivo: Evaluar el atributo de "equidad" asignado al Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Material y métodos: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017. Se compararon las diferencias inter-día de respuestas correctas (regresión linear multivariable) y de sustentantes que alcanzaron el puntaje mínimo de su especialidad (PME) (razón de momios [RM]). Se estimó a los afectados por la inequidad. Resultados: Hubo 36 114 sustentantes en 2016 y 38 380 en 2017. Los días 2 (ENARM-2016) y 1-2 (ENARM-2017) registraron puntajes significativamente más altos, y más sustentantes alcanzaron el PME que en los días 1-3-4 (RM 1.55) y 5 (RM 3.8) en 2016, y los días 3-4 (RM 1.85) y 5 (RM 4.04) en 2017. Se estimó que cuatro de cada diez sustentantes que aprobaron el ENARM no lo hubieran hecho si el examen fuera equitativo. Conclusión: Los resultados sugieren que el atributo de equidad del ENARM está en duda.

Prevalence of alexithymia in eating disorders in a clinical sample of 800 Mexican patients. / Prevalencia de alexitimia en los trastornos de la conducta alimentaria en una muestra clínica de 800 pacientes mexicanas

Introduction: The inability to identify, express feelings, and not distinguish between emotions and bodily sensations, is known as alexithymia. In 1988, it developed The Toronto Alexithymia Scale (TAS-20), consists of 20 items and three factors: a) difficulty of identifying feelings and differences between feelings and bodily sensations; b) difficulty of describing feelings; and c) externally oriented thinking. It's considered that people with eating disorders have specific deficits in identify and communicate their feelings. Objective: The present study has as purpose to the instrument validation. Methods: It was a cross-sectional study and psychometric character design of a single sample, formed of 435 persons suffering eating disorder (ED), with an age range of 12-68 years, of which 91% were women and 9% were men. To obtain the reliability of the instrument, applies internal consistency test, which resulted in an alpha of 0.89, then applied a factor analysis of principals components with oblimin rotation. Results: According to statistical analysis, were eliminated six items, so the scale finished with 14 items, and to analyze it observed that these items correspond with the two main factors of the original scale. The ED patients present alexithymia. Discussion: The scale satisfies the criteria of validity necessary for use in this population.

Introducción: La incapacidad para identificar y expresar sentimientos, y no distinguir entre las emociones y las sensaciones corporales, se conoce como alexitimia. En 1988 se desarrolló la Escala de Alexitimia de Toronto (TAS-20), que está conformada por 20 reactivos y tres factores: a) dificultad para identificar los sentimientos y las diferencias entre sentimientos y sensaciones corporales; b) dificultad para describir sentimientos; y c) pensamiento orientado externamente. Se considera que las personas con trastornos de la conducta alimentaria (TCA) tienen déficits específicos en la identificación y la comunicación de sus sentimientos. Objetivo: Realizar la validación de dicho instrumento. Método: Estudio de tipo transversal y de carácter psicométrico con diseño de una sola muestra, conformada por 435 personas con diagnóstico de TCA, con un rango de edad de 12 a 68 años, de las cuales el 91% eran mujeres y el 9% eran hombres. Para obtener la confiabilidad del instrumento se aplicó una prueba de consistencia interna, que dio como resultado un alfa de 0.89; posteriormente se hizo un análisis factorial de componentes principales con rotación oblimin. Resultados: De acuerdo con el análisis estadístico, se eliminaron seis reactivos, de tal forma que la escala finalizó con 14 reactivos, y al analizarlos se observó que concordaban con los dos factores principales de la escala original. Las pacientes con TCA presentan alexitimia. Discusión: La escala satisface los criterios de validez necesarios para ser utilizada en dicha población.

Legibilidad, relevancia y calidad de la información en español en la Web para pacientes con artritis reumatoide / Readability, relevance and quality of the information in Spanish on the Web for patients with rheumatoid arthritis

La educación es un determinante mayor de salud y uno de los predictores independientes de desenlace en artritis reumatoide (AR). El uso del Internet por pacientes ha crecido en forma exponencial en la última década. Objetivos. Evaluar las características, legibilidad y calidad de la información disponible en Internet en idioma español en relación con la AR. Material y métodos. Se buscó la frase AR en Google. Se evaluaron las primeras 30 páginas de resultados de acuerdo con un formato diseñado ex profeso (relevancia, autoría, tipo de publicación, enfermedad discutida e interés financiero); además se evaluaron la calidad y la legibilidad de las páginas, con las herramientas DISCERN e INFLESZ, respectivamente. La extracción de datos se realizó por médicos pasantes y la evaluación fue por consenso. Resultados. Se obtuvieron 323 resultados, pero solo el 63% de ellos fueron relevantes; el 80% de estos fueron sitios de información (71% discutían exclusivamente AR, 44% terapia convencional y 12% terapias alternativas). Un 12,5% tenía interés financiero. El 60% de los sitios fueron creados por organizaciones no lucrativas y 15% por asociaciones médicas. Las asociaciones médicas de Estados Unidos de América se posicionan mejor en español (Arthritis Foundation en la posición 4 y el American College of Rheumatology en la 10) que los sitios web de países de habla hispana. Conclusiones. Existe riesgo de desinformación para los pacientes con AR que utilizan la Web. Se identifica además áreas de oportunidad para instituciones médicas de países de habla hispana para tener un mayor involucramiento social en la educación de sus pacientes (AU)

Background. Education is a major health determinant and one of the main independent outcome predictors in rheumatoid arthritis (RA). The use of the Internet by patients has grown exponentially in the last decade. Objective. To assess the characteristics, legibility and quality of the information available in Spanish in the Internet regarding to rheumatoid arthritis. Material and methods. The search was performed in Google using the phrase rheumatoid arthritis. Information from the first 30 pages was evaluated according to a pre-established format (relevance, scope, authorship, type of publication and financial objective). The quality and legibility of the pages were assessed using two validated tools, DISCERN and INFLESZ respectively. Data extraction was performed by senior medical students and evaluation was achieved by consensus. Results. The Google search returned 323 hits but only 63% were considered relevant; 80% of them were information sites (71% discussed exclusively RA, 44% conventional treatment and 12% alternative therapies) and 12.5% had a primary financial interest. 60% of the sites were created by nonprofit organizations and 15% by medical associations. Web sites posted by medical institutions from the United States of America were better positioned in Spanish (Arthritis Foundation 4th position and American College of Rheumatology 10th position) than web sites posted by Spanish speaking countries. Conclusions. There is a risk of disinformation for patients with RA that use the Internet. We identified a window of opportunity for rheumatology medical institutions from Spanish-speaking countries to have a more prominent societal involvement in the education of their patients with RA (AU)

[Early neonatal sepsis and associated factors]. / Sepsis neonatal temprana y factores asociados.

BACKGROUND: Early-onset neonatal sepsis (EONS) is an infectious disease of low incidence but high morbidity and mortality with severe consequences to the newborn prognosis. Identifying the associated factors related to EONS allows to start a timely treatment and to take preventive measures. METHODS: In this case and controls study we identified all the newborns (NB) with and without EONS (cases and controls), diagnosed through blood culture in a period of three years. We studied risk factors such as: low gestational age, gender, weight, maternal infections, and premature rupture of membranes. RESULTS: Our study consisted of 27 cases and 36 controls, with a mean age of 32.43 and 33.19 weeks of gestation (WOG), respectively (p > 0.05). Of these, 22 and 29 of the cases and controls had a gestational age < 37 WOG, (p > 0.05). However, maternal infection (odds ratio [OR] 1.76), respiratory distress syndrome (OR 4.72), the need of resuscitation (OR 2.9), intubation (OR 5.1) and ventilation support (OR 2.6) were statistically different between both groups (p < 0.05). The most isolated microorganism was Staphylococcus coagulase negative (42.3%). CONCLUSIONS: Risk factors associated with EONS were maternal infection, the need of resuscitation, and intubation to ventilation support.

Introducción: la sepsis neonatal es un problema de baja incidencia, pero de elevada morbimortalidad y consecuencias severas para el pronóstico del recién nacido (RN). Conocer los factores asociados a sepsis neonatal temprana (SNT) permite iniciar un tratamiento oportuno y tomar medidas preventivas. Métodos: en este estudio de casos y controles identificamos a todos los RN con y sin SNT (casos y controles), diagnosticada con hemocultivo, en un periodo de tres años. Estudiamos los factores de riesgo para SNT: baja edad gestacional, peso, sexo, patologías maternas y ruptura prematura de membranas. Resultados: pudimos captar un total de 27 casos y 36 controles, con una edad promedio de 32.43 y 33.19 semanas de gestación (SDG), respectivamente (p > 0.05). Respectivamente 22 y 29 de los casos y controles tuvieron una edad < 37 SDG (p > 0.05). Sin embargo, la presencia de enfermedad materna, la necesidad de reanimación, intubación y apoyo ventilatorio fueron estadísticamente diferentes entre ambos grupos (p < 0.05). El microorganismo más frecuentemente aislado fue el Staphylococcus coagulasa negativo (42.3%). Conclusión: los factores asociados a SNT fueron la presencia de enfermedad materna, la necesidad de reanimación y la intubación para apoyo ventilatorio.

Expression of TREM-1 in maternal leukocytes in preterm, prelabour rupture of the membranes.

Studies have shown that triggering receptor expressed on myeloid cells-1 (TREM-1) is the mediator and activator of neutrophils and monocytes after stimulation with lipopolysaccharide (LPS), heat-inactivated Gram (-) bacteria, Gram (+) bacteria or fungi. Different studies have measured the expression of TREM-1 in patients with bacterial infections and critical states. The purpose of this study was to evaluate the expression of TREM-1 in circulating maternal leukocytes in premature rupture of the membranes (PRM). Two groups of patients were included in this case control study: pregnant women with PRM and healthy controls. All patients were free of any infection, including cervix and urinary tract. Although all patients expressed TREM-1 to some extent, there was no statistically significant difference in the expression of different cellularities in both groups; except for the mononuclear leukocytes (p < 0.05). In this study, TREM-1 was not altered in PRM.

Readability, relevance and quality of the information in Spanish on the Web for patients with rheumatoid arthritis. / Legibilidad, relevancia y calidad de la información en español en la Web para pacientes con artritis reumatoide.

BACKGROUND: Education is a major health determinant and one of the main independent outcome predictors in rheumatoid arthritis (RA). The use of the Internet by patients has grown exponentially in the last decade. OBJECTIVE: To assess the characteristics, legibility and quality of the information available in Spanish in the Internet regarding to rheumatoid arthritis. MATERIAL AND METHODS: The search was performed in Google using the phrase rheumatoid arthritis. Information from the first 30 pages was evaluated according to a pre-established format (relevance, scope, authorship, type of publication and financial objective). The quality and legibility of the pages were assessed using two validated tools, DISCERN and INFLESZ respectively. Data extraction was performed by senior medical students and evaluation was achieved by consensus. RESULTS: The Google search returned 323 hits but only 63% were considered relevant; 80% of them were information sites (71% discussed exclusively RA, 44% conventional treatment and 12% alternative therapies) and 12.5% had a primary financial interest. 60% of the sites were created by nonprofit organizations and 15% by medical associations. Web sites posted by medical institutions from the United States of America were better positioned in Spanish (Arthritis Foundation 4th position and American College of Rheumatology 10th position) than web sites posted by Spanish speaking countries. CONCLUSIONS: There is a risk of disinformation for patients with RA that use the Internet. We identified a window of opportunity for rheumatology medical institutions from Spanish-speaking countries to have a more prominent societal involvement in the education of their patients with RA.

Fifteen-year trend in information on the World Wide Web for patients with rheumatoid arthritis: evolving, but opportunities for improvement remain.

The aim of this study was to assess the changes in the characteristics of rheumatoid arthritis information on the Internet over a 15-year period and the positioning of Web sites posted by universities, hospitals, and medical associations. We replicated the methods of a 2001 study assessing rheumatoid arthritis information on the Internet using WebCrawler. All Web sites and pages were critically assessed for relevance, scope, authorship, type of publication, and financial objectives. Differences between studies were considered significant if 95 % confidence intervals did not overlap. Additionally, we added a Google search with assessments of the quality of content of web pages and of the Web sites posted by medical institutions. There were significant differences between the present study's WebCrawler search and the 2001-referent study. There were increases in information sites (82 vs 36 %) and rheumatoid arthritis-specific discussion pages (59 vs 8 %), and decreases in advertisements (2 vs 48 %) and alternative therapies (27 vs 45 %). The quality of content of web pages is still dispersed; just 37 % were rated as good. Among the first 300 hits, 30 (10 %) were posted by medical institutions, 17 of them in the USA. Regarding readability, 7 % of these 30 web pages required 6 years, 27 % required 7-9 years, 27 % required 10-12 years, and 40 % required 12 or more years of schooling. The Internet has evolved in the last 15 years. Medical institutions are also better positioned. However, there are still areas for improvement, such as the quality of the content, leadership of medical institutions, and readability of information.

[Correlation between gait speed and muscular strength with balance for reducing falls among elderly]. / Correlación entre velocidad de marcha y fuerza muscular con equilibrio para reducir caídas en ancianos.

BACKGROUND: Evidence of the benefit on propioceptive neuromuscular facilitation for reducing falls in older people does not exist. OBJECTIVE: The aim of this study is to evaluate the effects of propioceptive facilitation over falls and biomechanical variables, in comparison to standard treatment and control groups. MATERIALS AND METHODS: Series cases comparative for the 24 participants were recruited and randomnly assigned to 3 groups. Group 1, propioceptive neuromuscular facilitation, group 2, standard treatment, and 3 control. Falls and biomechanic variables were measured before and after. Chi(2) was used for falls and multiple regression for biomechanical variables, RESULTS: Participants had similar falls in previous year. Women had higher falls in a relation 7:1 women-men. After intervention, there was no difference between 3 groups. A correlation exista between muscular strength and gait speed with one foot position time r(2) = 0.67, p = 0.02. CONCLUSIONS: Improving 1kilogram-force of muscular strength of pelvic limb and 0.1meter/second in gait speed, balance (unipodal position time) increases balance by 11.3%. After 3 months of intervention group 2 got 7.9kg-force and 0.26m/s of profit, while group 1 had 4.1kg-force and 0.15m/s and control group 2.4kg-force and 0.1m/s.

[Acute responses on lipid profile by practicing cycling]. / Acondicionamiento físico y respuesta aguda en la concentración de lípidos séricos. La práctica de ciclismo fijo.

BACKGROUND: it has been demonstrated an association between the increase in physical activity and improvements in the lipid profile. OBJECTIVE: to evaluate changes in the serum lipids caused by spinning practice. METHODS: nine men and twelve women were studied, they underwent to an initial evaluation that included a treadmill effort test, in order to establish the physical fitness level. With the purpose of determine the lipids change, a blood sample was obtained before and after a typical spinning session. The design was prospective, experimental, longitudinal and comparative study. Student's t-test and regression model were used to determine the changes in the lipids concentrations, and its relation with the physical fitness level. A p value < or = 0.05 was required for statistical significance. RESULTS: lipids increase concentrations were observed (p < 0.05), except at triglycerides in men, in which it had a decrease. It was statistically significant relation between the physical fitness level and the percentage of high-density lipoproteins variation (r = 0.44, p = 0.046). CONCLUSIONS: the percentage of high-density lipoproteins variation was greater when the values of VO(2)max were higher. At greater level of medical fitness greater positive answer in this lipoproteins. In the case of the rest serum lipids, it was not observed relation between the level of medical fitness and the percentage of variation due to the execution of the spinning session.

[Exploratory study of ethics, norms and communication skills in medical residents]. / Estudio exploratorio de los conocimientos sobre ética, normativa y comunicación en los aspirantes a residencias médicas.

Medical schools teach technical-scientific knowledge more than social abilities. Confidence in the doctor-patient relationship is obtained through appropriate communication. The predominant medical education model assumes that communication abilities are acquired by the experienced physician in clinical practice. The present study presents a first approach and exploration of three central subjects for the development of a suitable doctor-patient relationship. We observed that the integration of evaluated knowledge was low: communication 21.1%, ethics 40.5%, legal issues 0.1% and doctor-patient conflicts 1.5%. In the analysis of communication models by genre, we found that women were more paternalist and men were more deliberative; the predominant model of communication is paternalism (40.2%). Physicians between 21 and 25 years of age integrated the knowledge better (communication, ethics and doctor-patient conflicts) than at other ages. Physicians between 41 and 45 years of age integrated ethical concepts with significantly less frequency. Parental education was associated with models of communication and integration of knowledge (p <0.001). The results demonstrate the lack of knowledge related to these topics.

[Hydration status and aerobic capacity: effects on plasmatic volume during strenuous physical exercise]. / Estado de hidratación y capacidad aeróbica: sus efectos sobre el volumen plasmático durante el ejercicio físico agudo.

INTRODUCTION: During exercise, water loss frequently occurs in the intracellular spaces and there is a decrease in the plasmatic volume, with a blood concentration as a secondary characteristic. Plasmatic volume losses provoke a decrease in the blood flow, which directly affects cardiac function. Physical performance decreases and aerobic capacity deteriorates. MATERIAL AND METHODS: An observational, prospective, longitudinal, and comparative study was carried out to evaluate gender influence and the aerobic capacity level upon hydration and the plasmatic volume produced by maximal physical exercise. Twenty four individuals between 18 and 35 years old were included. All participated in aerobic physical exercise and changes in hemoglobin, hematocrit, plasmatic volume, and hydration state were evaluated. RESULTS: Gender showed a significant influence on plasmatic volume but not on the hydration state. The aerobic capacity presented a relationship with plasmatic volume, and the plasmatic volume with the hydration state. Women presented more plasmatic volume loss than men (p < 0.05). Individuals who have adequate aerobic capacity tend to lose less plasmatic volume during exercise. CONCLUSIONS: Maximal physical exercise during a short period also leads to important liquid loss; therefore, it is important that people who engage in exercise understand their liquid losses and re-hydrate themselves appropriately before, during, and after exercise.

[Defensive medicine in Mexico: an explorative survey of its characteristics]. / Medicina defensiva en México: una encuesta exploratoria para su caracterización.

INTRODUCTION: defensive medicine, has been recognized as a problem for health services in several countries of the world. It is defined as the application of treatments, tests and procedures with the main intention to defend the doctor of critic's and to avoid controversies, regarding diagnosis or patient's treatment. There are multiple causes of the defensive medicine: the fundamental is patient doctor relationship without the necessary trust. MATERIAL AND METHODS: the present reports it is a observational, cross-sectional and descriptive study of exploratory nature, with the objective to consider the dimension of the defensive medicine (MD) in Mexico. A survey was designed to pilot an application with Likert scale in a representative sample. 613 doctors participated to national level, with index of confidence of 95% and maximum error of 5% (p < 0.05). The questions explore the level in agreement or disagreement with perceptions, specific attitudes and conducts that are related to the MD practice. RESULTS: categories and degrees in the defensive practices of the interviewed doctors settled down, 38,7% were nondefensive, whereas 61,3% presented association with some MD degree (p < 0.05). CONCLUSIONS: The defensive attitude of the participant doctors is high, it emphasizes the importance of establishing measures that stimulate their containment and fights, which will allow to improve the quality of the medical practice and the doctor-patient relationship. The instrument maintained a degree of confidence and sensitivity (p < 0.05), that its future use allows.

[Assertive medicine: a proposal against defensive medicine]. / Medicina asertiva: una propuesta contra la medicina defensiva.

More than ever the physician-patient relationship is deteriorated by diverse factors, among these liability complaints stand out, and have propitiated the practice of defensive medicine, an attitude considered in many countries as inappropriate, expensive and unethical. Defensive medicine widens the distance between a physician and his patient. To revert this vice and its noxious effects which corrupt the patient-physician relationship in our country, we propose that physicians put to practice actions which permit the renewal of the essence of humanistic medicine in their daily practice and the restoration of the relationship. These changes in attitude sum up to a proposition of professional practice which we have denominated assertive medicine. This offer is resumed in four points: 1) Maintain a proper verbal and non verbal communication with each patient, 2) Keep continuously up to date skills, knowledge and abilities, 3) Respect the patient's rights and 4) Defend their own rights as physicians.

Recomendaciones para mejorar la práctica odontológica / Recommendations to improve dental practice

Introducción: las alteraciones estomatológicas tienen una alta incidencia de acuerdo con la Organización Mundial de la Salud, en México se estima que el 90 por ciento de la población padece caries. Objetivo: identificar los principales conflictos por atención odontológica, manifestados en las quejas recibidas en la CONAMED, identificar sus principales características y emitir recomendaciones dirigidas a mejorar la calidad de la práctica odontológica. Metodología: se obtuvo información sobre las quejas recibidas en la CONAMED del área de odontología (enero de 2001 a octubre de 2002); una vez elaboradas las recomendaciones fueron sometidas a un grupo de validación externa integrado por expertos en le área. Resultados: se analizaron 177 quejas; 63,3 por ciento correspondientes a mujeres y 36,7 por ciento a hombres. El grupo de edad más afectado fue el de 25-44 años con 35 por ciento; 91 por ciento de quejas fueron de servicios privados. Los motivos de queja más frecuentes estaban relacionados con el tratamiento en 75.7 por ciento de los casos. Los principales procedimientos realizados fueron: 25.6 por ciento de ortodoncia, 24,4 por ciento prótesis y 13,3 por ciento endodoncia; el resto sin datos significativos. La principal modalidad de conclusión de las quejas fue la conciliación (53.1 por ciento). En un subanálisis de (n=100) se idenetificó mala práctica en 43 por ciento de casos. Asimismo, se identificaron problemas cuyo origen se encuentra en la falta de comunicación o problemas de comunicación en la relación del profesional de la salud bucal-paciente. Conclusiones: los factores identificados en las quejas, tales como la falta de comunicación ante el profesional y el paciente, falsas expectativas de los pacientes y el incumplimiento de las recomendaciones elaboradas

[An exploratory approach on teaching for prevention of medical error]. / Estudio exploratorio sobre la enseñanza de la comunicación humana asociado a la práctica médica.

INTRODUCTION: Medical error is prevalent in the contemporary practice of medicine. Prevention and solution of the majority of medical errors can be focused upon from the early stages of physician formation by improving knowledge and abilities with regard to human communication. Despite its importance, information systematized with empirical bases on the teaching of human communication in Mexico is non-existent. PURPOSE: Our purpose was to highlight the experience of an exploratory nature on the educative intervention on human communication in medicine in medical residents of different medical specialties. METHODS: A study of educational intervention was presented 216 medical residents of the National Institutes of Health in Mexico City on the topic of human communication in medical practice. Chi square distribution was employed to find associations among variables. RESULTS: Eighty percent of students presented deficiencies in knowledge and thinking abilities for clinical communication. As a result of the educational intervention, 70 percent of medical resident students reached acceptable significant learning on the topic. There were no appreciable differences between the men and women in response patterns. Data indicated necessity of incorporating this topic pre-and postgraduate studies, to achieve improvement of quality of medical care and prevention of conflicts in medicine.