Análisis de costos de la detección de microglobulina alfa 1 placentaria en el abordaje de la sospecha de amenaza de parto pretérmino / Cost analysis of the alpha 1 placental microglobulin measurement as screening on suspected preterm labor

Objetivo: identificar el potencial beneficio económico de implementar la medición de microglobulina alfa 1 placentaria en las usuarias con sospecha de amenaza de parto pretérmino que acceden al Servicio de Emergencias del Hospital de las Mujeres Dr. Adolfo Carit Eva, como mecanismo para la reducción del impacto en la mortalidad maternoinfantil y optimizar recursos económicos en la Caja Costarricense de Seguro Social. Métodos: estudio económico, de enfoque cuantitativo-retrospectivo, con diseño transversal. Se consultaron fuentes secundarias del Departamento de Registros Médicos y Estadística del Hospital de las Mujeres Dr. Adolfo Carit Eva y se calculó el costo de atención de las pacientes hospitalizadas por diagnóstico de "trabajo de parto falso antes de las 37 semanas completas de gestación", según la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud, décima revisión (CIE-10), en comparación con el hipotético escenario de que, en el mismo evento de salud, se implemente la medición cualitativa de microglobulina alfa 1 placentaria. Para el análisis de los datos se determinaron los costos tanto individuales como colectivos en pruebas diagnósticas de control, así como el costo hospitalario y de tratamiento médico, lo cual permitió estimar los costos individuales, totales y promedio del ingreso innecesario de estas usuarias. Para el cálculo de costos de sospecha de amenaza de parto pretérmino descartada, se plantearon los siguientes escenarios: internamiento de la totalidad de pacientes con sospecha de una posible amenaza de parto pretérmino (n=60) y la utilización de la prueba cualitativa de microglobulina alfa1 placentaria, tomando en consideración su valor predictivo negativo (97%). Posteriormente, se estimó el valor del cociente costo/ahorro (el cual se interpreta como beneficioso en caso de ser menor a 1 y no beneficioso en caso de ser mayor a 1). Resultados: se reportó una incidencia de parto pretérmino de 10,1%; los costos derivados de la atención a pacientes con sospecha de parto pretérmino provienen principalmente de la hospitalización. Se obtiene un costo mínimo por paciente de ¢3 317 071,21 colones que se traducen a $5 593,79 USD según tipo de cambio vigente el 30 de noviembre del 2019, de acuerdo con el Banco Central de Costa Rica. Por su parte, se estima un costo máximo de 6 356 780, 1 colones, lo que equivale a 11 219,96 USD al tipo de cambio vigente el 30 de noviembre del 2019. Por lo cual, una vez determinado el supuesto escenario de la implementación de la prueba de microglobulina alfa 1 placentaria en las pacientes que consultan a Emergencias por sospecha de amenaza de parto pretérmino, se demuestra que existe un potencial ahorro efectivo de recursos. Conclusión: Se recomienda tomar como referente el valor predictivo negativo de microglobulina alfa 1 placentaria en su medición cualitativa, como prueba diagnóstica auxiliar en el manejo de la sospecha de amenaza de parto pretérmino. Empero, es necesario efectuar estudios complementarios para estimar el valor predictivo positivo y otros estudios económicos para valorar la incorporación de esta prueba en el algoritmo de atención de las amenazas de parto pretérmino.

Aim: identify the possible economic benefit of implementing the measurement of placental alpha 1 microglobulin in users with suspected Preterm Labor Threat, who access the emergency service of the Hospital de The Women Dr. Adolfo Carit Eva, as a mechanism to impact on maternal and infant mortality and economic resources in the Costa Rican Social Security Fund. Methods: economic study, quantitative-retrospective approach, with cross-sectional design. This study included the consult of secondary sources of the Department of Medical Records and Statistics of the Hospital; where the cost of care for hospitalized patients diagnosed with ICD-10 "False Labor before 37 weeks" is calculated; compared to a hypothetical scenario where the qualitative measurement of placental alpha 1 microglobulin is implemented for this same health event. For the data analysis, both individual and collective costs were determined in diagnostic control tests, as well as hospital and medical treatment costs, which allowed estimating the individual, total and average costs of admission of these users. To calculate the costs of suspected Preterm Labor Treat ruled out, the following scenarios were proposed: hospitalization of all patients in whom a possible Preterm Labor Treat is suspected (n= 60) and use of the qualitative placental alpha1 microglobulin test, taking into account their negative predictive value (97%). Subsequently, the value of the cost/savings ratio is estimated (interpreted as beneficial if it is less than 1 and not beneficial otherwise). Results: An incidence of preterm delivery of 10.1% was reported; the costs derived from the care of patients with suspected preterm delivery come mainly from hospitalization. Therefore, when developing the respective cost analysis, it is evident that the economic benefit of to incorporate qualitative measurement of placental alpha 1 microglobulin is derived mainly from the decrease in hospitalization. A minimum cost per patient of 3,317,071.21 colones is obtained, which translates to 5,593.79 dollars at the exchange rate in force on November 30, 2019 according to the Central Bank of Costa Rica. For its part, a maximum cost of 6,356,780.1 colones is estimated, which translates to 11,219.96 dollars at the exchange rate in effect on November 30, 2019. Therefore, once the assumed scenario of the implementation of the placental alpha1 microglobulin test in patients who consult the Emergencies for suspected Preterm Labor Threat has been determined, there is a potential effective saving of resources. Conclusion: the use of the qualitative measurement of placental alpha 1 microglobulin, as an auxiliary diagnostic test in the management of the suspected threat of preterm delivery, it is recommended, from take the negative predictive value as a reference. However, it is necessary to carry out complementary studies to estimate the positive predictive value and other economic studies to include this test in the care algorithm of the Preterm Labor Threat.

Corrigendum: Comparison of Personal, Social and Academic Variables Related to University Drop-out and Persistence.

[This corrects the article on p. 1610 in vol. 7, PMID: 27803684.].

Comparison of Personal, Social and Academic Variables Related to University Drop-out and Persistence.

Dropping out of university has serious consequences not only for the student who drops out but also for the institution and society as a whole. Although this phenomenon has been widely studied, there is a need for broader knowledge of the context in which it occurs. Yet research on the subject often focuses on variables that, although they affect drop-out rates, lie beyond a university's control. This makes it hard to come up with effective preventive measures. That is why a northern Spanish university has undertaken a ex post facto holistic research study on 1,311 freshmen (2008/9, 2009/10, and 2010/11 cohorts). The study falls within the framework of the ALFA-GUIA European Project and focuses on those drop-out factors where there is scope for taking remedial measures. This research explored the possible relationship of degree drop-out and different categories of variables: variables related to the educational stage prior to university entry (path to entry university and main reason for degree choice), variables related to integration and coexistence at university (social integration, academic integration, relationships with teachers/peers and value of the living environment) financial status and performance during university studies (in terms of compliance with the program, time devoted to study, use of study techniques and class attendance). Descriptive, correlational and variance analyses were conducted to discover which of these variables really distinguish those students who drop-out from their peers who complete their studies. Results highlight the influence of vocation as main reason for degree choice, path to university entry, financial independency, social and academic adaptation, time devoted to study, use of study techniques and program compliance in the studied phenomenon.

Tumor del estroma gastrointestinal gástrico con metástasis inusual al cráneo / Gastric gastrointestinal stromal tumor with unusual skull metastasis

Los tumores del estroma gastrointestinal GIST, se originan en la pared del tracto digestivo desde el esófago al ano. Aproximadamente 25% de los GIST gástricos son clínicamente malignos y desarrollan metástasis principalmente al hígado, menos comúnmente a tejidos blandos y hueso. Se presenta el caso de un paciente con GIST gástrico y metástasis al hígado e inusualmente al cráneo.

Gastrointestinal stromal tumors (GISTs) originate in the wall of the digestive tract from the esophagus to the anus. Approximately 25% of gastric GISTs are clinically malignant. Most often they metastasize to the liver, less commonly to soft tissues and bone. The clinical case of a patient with a gastric GIST, liver and unusual cranial metastasis is presented.

Spindle cell oncocytoma of the adenohypophysis.

Spindle cell oncocytoma of the adenohypophysis (SCO) is defined as spindle to epithelioid cells with oncocytic appearance presenting in the adenohypophysis. In contrast to pituitary adenomas, the SCO does not show immunoreactivity for neuroendocrine markers and pituitary hormones but co-expressed vimentin, S-100 protein, epithelial membrane antigen (EMA), and antimitochondrial antibody MU213-UC clone 131-1. We describe an SCO in an adult, a 42-year-old woman whose magnetic resonance (MR) images documented an intrasellar lesion located in the hypophysis. Histopathological examination showed a tumor composed predominantly of spindle cells. Immunohistochemical studies showed positivity for vimentin, S10, EMA, and antimitochondrial antibody MU213-UC clone 131. Cytokeratin (CK) (AE1/AE3), glial fibrillary acidic protein (GFAP), chromogranin, synaptophysin, PGP9.5, CD57, desmin, D2-40, smooth muscle actin (SMA), Bcl-2, progesterone receptor, and CD34 were negative. Neuropeptides were negative. With electron microscopy, the neoplastic cells appear filled with mitochondria, well-formed desmosomes, but lacked secretory granules. SPO is a rare non-endocrine neoplasm of the adenohypophysis with benign biological behavior corresponding to WHO grade I.

Tumor fusocelular hialinizante con rosetas gigantes: reporte de un caso / Hyalinizing spindle cell tumor with giant rosettes: case report

Introducción: El tumor fusocelular hialinizante con rosetas gigantes es una neoplasia constituida por dos componentes histológicos, uno celular con elementos fusiformes, y el segundo representado por islas bien delimitadas casi acelulares, llenas de material hialino, rodeadas de células redondas u ovales, las cuales muestran un perfil inmunohistoquímico inusual, e histogénesis incierta. Objetivo: instruir a los patólogos y clínicos sobre este tumor, su forma de presentación y diagnósticos diferenciales. Metodología y resultados: Se presenta el caso de una mujer de 42 años con masa ubicada en región inguinal, de crecimiento progresivo (1 año), que se reseca quirúrgicamente anatomía patológica informó un tumor fusocelular hialinizante con rosetas gigantes, según hallazgos morfológicos e inmuno histoquímicos, en correlación con su localización y cuadro clínico. Conclusión: Se hace necesario ampliar el conocimiento sobre esta entidad y de esta forma obtener una adecuada evaluación de sus criterios pronósticos histológicos, comportamiento clínico y tratamiento.

Introduction: The hyalinizing spindle cell tumor with giant rosettes is a neoplasia characterized by both histologic components, one of which is cellular, with spindle-shaped elements and the second represented by well defined almost acellular islands filled with hyaline material surrounded by round to oval cells, which shows an unusual immunohistochemical profile and uncertain histogenesis. Objective: Educate pathologists and clinicians about this tumor, its presentation and differential diagnosis. Methods and results: A case of a 42 year old woman with a mass located in the inguinal region, with progressive growth (1 year), surgically resected and histopathology reported as Hyalinizing spindle cell tumor with giant rosettes according to morphological, immunohistochemical findings correlates with its location and clinical. Conclusion: It is necessary to expand awareness about this condition and thus obtain a proper assessment of histological prognostic criteria, clinical behavior and treatment.

Academic procrastination: associations with personal, school, and family variables.

Procrastination is a common behavior, mainly in school settings. Only a few studies have analyzed the associations of academic procrastination with students' personal and family variables. In the present work, we analyzed the impact of socio-personal variables (e.g., parents' education, number of siblings, school grade level, and underachievement) on students' academic procrastination profiles. Two independent samples of 580 and 809 seventh to ninth graders, students attending the last three years of Portuguese Compulsory Education, have been taken. The findings, similar in both studies, reveal that procrastination decreases when the parents' education is higher, but it increases along with the number of siblings, the grade level, and the underachievement. The results are discussed in view of the findings of previous research. The implications for educational practice are also analyzed.

Academic Procrastination: Associations with Personal, School, and Family Variables

Procrastination is a common behavior, mainly in school settings. Only a few studies have analyzed the associations of academic procrastination with students’ personal and family variables. In the present work, we analyzed the impact of socio-personal variables (e.g., parents’ education, number of siblings, school grade level, and underachievement) on students’ academic procrastination profiles. Two independent samples of 580 and 809 seventh to ninth graders, students attending the last three years of Portuguese Compulsory Education, have been taken. The findings, similar in both studies, reveal that procrastination decreases when the parents’ education is higher, but it increases along with the number of siblings, the grade level, and the underachievement. The results are discussed in view of the findings of previous research. The implications for educational practice are also analyzed (AU)

La procrastinación es un comportamiento muy frecuente, sobre todo entre la población escolar. Pocos estudios han analizado las relaciones entre la procrastinación académica y variables personales y familiares. En este trabajo analizamos el impacto de variables socio-personales tales como la escolaridad de la madre y del padre, el número de hermanos, el curso y el fracaso escolar evaluado a través del número de cursos suspensos utilizando ANOVAS en dos muestras independientes de 580 y 809 sujetos de los 3 primeros cursos de Enseñanza Secundaria Obligatoria (ESO). Los datos, similares en los dos estudios, revelan que la procrastinación decrece con el aumento de escolaridad de la madre y del padre, pero incrementa con el número de hermanos, el curso en ESO y el fracaso escolar. Los resultados son discutidos en función de los hallazgos de las investigaciones previas. Se analizan las implicaciones para la práctica educativa (AU)

[Evaluating the efficacy of a program to enhance college students' self-regulation learning processes and learning strategies]. / Eficacia de un programa instruccional para la mejora de procesos y estrategias de aprendizaje en la enseñanza superior.

The present study examines the efficacy of a program designed to enhance college students'learning processes and study strategies. The program was organised around a number of letters written by a freshman, Gervásio (Rosário, Núñez, & González-Pienda, 2006), telling about his new experiences, troubles, and successes in the university. This intervention program is intended to promote a series of strategies (cognitive, meta-cognitive, and supportive) which allow students to manage their learning processes in a more proficient, successful, and autonomous way. The collected data suggest that students who had the opportunity to follow the program significantly improved their declarative knowledge about learning strategies, reduced their use of surface approaches to study, and extended the newly acquired skills to new and different tasks and assignments.

Eficacia de un programa instruccional para la mejora de procesos y estrategias de aprendizaje en la enseñanza superior / Evaluating the efficacy of a program to enhance college students' self-regulation learning processes and learning strategies

En este trabajo se analiza la eficacia de un proyecto de promoción de procesos y estrategias de aprendizaje en la Universidad. El programa se organiza en torno de una serie de cartas escritas por Gervásio, un alumno recién llegado a la Universidad (Rosario, Núñez, y González-Pienda, 2006) sobre sus experiencias, dificultades y éxitos ocurridos en esta nueva etapa de su vida académica. El programa está orientado para dotar a los alumnos universitarios de un conjunto de estrategias (cognitivas, metacognitivas y de apoyo) que les permitan abordar sus procesos de aprendizaje de una forma más competente y autónoma. Los datos obtenidos sugieren que los estudiantes que participan en el programa de capacitación mejoran significativamente en cuanto al dominio de conocimiento declarativo respecto de las estrategias de aprendizaje, disminuye el uso de un enfoque de estudio superficial y mejoran también en cuanto a la aplicación de estas habilidades a tareas novedosas (transferencia)

The present study examines the efficacy of a program designed to enhance college students'learning processes and study strategies. The program was organised around a number of letters written by a freshman, Gervásio (Rosário, Núñez, & González-Pienda, 2006), telling about his new experiences, troubles, and successes in the university. This intervention program is intended to promote a series of strategies (cognitive, meta-cognitive, and supportive) which allow students to manage their learning processes in a more proficient, successful, and autonomous way. The collected data suggest that students who had the opportunity to follow the program significantly improved their declarative knowledge about learning strategies, reduced their use of surface approaches to study, and extended the newly acquired skills to new and different tasks and assignments

El aprendizaje autorregulado como medio y meta de la educación / Self-regulating learning as a resource and a goal of education

En la actualidad, en los comienzos del siglo XXI, las principales necesidades a las que deben dar respuesta el sistema educativoy las leyes que lo amparen, y a las que trata de dar respuesta en la LOE son básicamente dos. Por un lado, proporcionaruna educación de calidad a todos los niveles del sistema educativo, lo que conlleva la necesidad de asumir un importante desafío:conseguir el éxito escolar de todos los jóvenes, que se traduce básicamente en mejorar el nivel educativo de todo elalumnado y lograr que alcancen el máximo desarrollo de todas sus capacidades. Por otro lado, actualmente, más que nunca,la educación debe preparar adecuadamente para vivir en la nueva sociedad del conocimiento y para afrontar los retos quede ella se deriven. En este artículo se aborda este tema central a todos los niveles educativos, analizando, principalmente, quéimplica estar capacitado para un aprendizaje autónomo y cómo promover dichas competencias en el aula

Nowadays, at the beginning of the XXI century, the main needs to be fulfilled by an educational system and the laws that supportit, and which the LOE expects to meet, are basically two. On the one hand, the first need is to provide with a high qualityeducation to all the educational system levels; which means the need to assume an important challenge: to achieve academicsuccess for young people; this idea basically means to improve the educational level of all students, and to obtain the highestdevelopment of all their abilities. On the other hand, nowadays, more than ever, education must prepare appropriately peopleboth to live in the new society of knowledge and to face the challenges derived from it. In this article, we tackle this main topicto all the educational levels; we essentially analyze what to be prepared for a self-governing learning means, and how to promotethese competences in the classroom

Escuela-familia: ¿es posible una relación recíproca y positiva? / School vs. family: Is it possible and a mutual agreement?

La educación de los estudiantes no es sólo responsabilidad de la escuela. En este artículo se reflexiona sobre la relación entreescuela y familia, entendiendo ésta como uno de los pilares sobre los que se fundamenta el éxito o fracaso de cualquier sistemaeducativo. Inicialmente, se aporta información sobre las diversas líneas de investigación que se han desarrollado sobre estetema para, posteriormente, centrar el análisis sobre el papel de las “tareas para casa” (TPC) como un inmejorable recursopara promover la implicación de la familia en el desarrollo académico de los hijos

Student’s education is not only a responsibility of the school. In this paper, we make a reflection about the relationship betweenparents and school, as one of the foundations where success or failure of any educational system is based. Initially, we provideinformation about the research lines developed about this topic; then, we concentrate our analysis on the role homework playsas an indispensable resource to improve parents’ implication on their children academic development

Olhares de género face à matemática: uma investigação no ensino obrigatório espanhol / Looking at Mathematics through gender: a study in Spanish compulsory education

O interesse pelo estudo das atitudes e o seu papel determinante na aprendizagem da matemática tem sido objecto de investigação há mais de 50 anos. Não obstante, actualmente, a investigação ainda se centra sobre as diferenças das atitudes das mulheres e dos homens, bem como sobre as causas de tais diferenças. No geral, os estudos realizados concluíram que, face à aprendizagem da matemática, as mulheres se percepcionam como menos competentes que os homens, embora estes estudos não sejam conclusivos. Outro dos dados emergentes sugere que, à medida que o estudante progride na escolaridade obrigatória, a atitude face à matemática vai sendo mais negativa. O presente trabalho aporta mais alguns dados sobre as diferenças nas atitudes face à matemática em função do género e do ano de escolaridade no contexto educativo espanhol.(AU)

Studying attitudes and their important role in learning Mathematics has been one of the concerns of research over the last fifty years. Nowadays research still deals with attitudes, but a new focus of interest comes to light: studying the differences between male and female attitudes and the reasons for that. Some existing studies state that females perceive themselves as less competent than males do in learning Mathematics but those studies are still not conclusive. Data also suggest that over school years students' attitudes grow more and more negative. The present study highlights the differences in attitudes towards Mathematics according to gender and school year in the Spanish educational context.(AU)

Olhares de género face à matemática: uma investigação no ensino obrigatório espanhol / Looking at Mathematics through gender: a study in Spanish compulsory education

O interesse pelo estudo das atitudes e o seu papel determinante na aprendizagem da matemática tem sido objecto de investigação há mais de 50 anos. Não obstante, actualmente, a investigação ainda se centra sobre as diferenças das atitudes das mulheres e dos homens, bem como sobre as causas de tais diferenças. No geral, os estudos realizados concluíram que, face à aprendizagem da matemática, as mulheres se percepcionam como menos competentes que os homens, embora estes estudos não sejam conclusivos. Outro dos dados emergentes sugere que, à medida que o estudante progride na escolaridade obrigatória, a atitude face à matemática vai sendo mais negativa. O presente trabalho aporta mais alguns dados sobre as diferenças nas atitudes face à matemática em função do género e do ano de escolaridade no contexto educativo espanhol.

Studying attitudes and their important role in learning Mathematics has been one of the concerns of research over the last fifty years. Nowadays research still deals with attitudes, but a new focus of interest comes to light: studying the differences between male and female attitudes and the reasons for that. Some existing studies state that females perceive themselves as less competent than males do in learning Mathematics but those studies are still not conclusive. Data also suggest that over school years students' attitudes grow more and more negative. The present study highlights the differences in attitudes towards Mathematics according to gender and school year in the Spanish educational context.

Evaluación de los procesos de autorregulación mediante autoinforme / Self regulation processes measurement through self-report methodology

La evaluación de los procesos de autorregulación del aprendizaje escolar se encuentra hoy en un momento crítico debido a los problemas que presenta su estimación a través de instrumentos tipo autoinforme. En este artículo presentamos los resultados obtenidos en un trabajo de investigación en el que se trató de averiguar en qué medida el mayor o menor grado de conciencia que el alumno tenga sobre el proceso de autorregulación del aprendizaje y estudio (y las estrategias y actividades implicadas en el mismo) tiene efectos significativos sobre la calidad de las respuestas dadas en instrumentos de evaluación tipo autoinforme. Para comprobar esta hipótesis se ha diseñado y realizado un experimento con medida pretest y postest, sin grupo control, en el cual han participado 90 estudiantes de diferentes cursos y licenciaturas. La intervención ha tenido una duración de 45 horas, distribuidas en 8 sesiones de 5 horas cada una, y ha consistido en el trabajo teórico-práctico de las estrategias y tareas implicadas en el proceso de autorregulación del aprendizaje y estudio académico. Los resultados obtenidos muestran que la información aportada por un instrumento autoinforme es significativamente más precisa después de la intervención y han sido interpretados en el sentido de que este tipo de intervención previo a la evaluación mejora sustancialmente la información obtenida mediante este tipo de instrumentos

Nowadays the evaluation of self-regulated learning processes is having a critical time due to the problems concerning the assessment instruments. This paper presents the outcomes of a research study having a main goal: evaluate to what extent student’s consciousness of his/her own self-regulated learning and study processes (and the involved strategies and activities) has a significant impact on the quality of his/her answers on self-report type instruments. In order to prove this hypothesis an experimental study was designed and built including a pre and a post-test, having no control group, using a sample of 90 college students from different degree courses. The intervention program lasted 45 hours, divided into 8 work sessions of 5 hours each. The developed work included both theoretical and practical tasks dealing with strategies and activities involved in the self-regulated learning and study processes. The results show that the collected data using a self-report instrument is much more significant and accurate after the intervention program has taken place and that the intervention greatly improves the obtained information using these kind of instruments

[Self regulation processes measurement through self-report methodology]. / Evaluación de los procesos de autorregulación mediante autoinforme.

Nowadays the evaluation of self-regulated learning processes is having a critical time due to the problems concerning the assessment instruments. This paper presents the outcomes of a research study having a main goal: evaluate to what extent student's consciousness of his/her own self-regulated learning and study processes (and the involved strategies and activities) has a significant impact on the quality of his/her answers on self-report type instruments. In order to prove this hypothesis an experimental study was designed and built including a pre and a post-test, having no control group, using a sample of 90 college students from different degree courses. The intervention program lasted 45 hours, divided into 8 work sessions of 5 hours each. The developed work included both theoretical and practical tasks dealing with strategies and activities involved in the self-regulated learning and study processes. The results show that the collected data using a self-report instrument is much more significant and accurate after the intervention program has taken place and that the intervention greatly improves the obtained information using these kind of instruments.