Molecular formula assignment of dissolved organic matter by ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry using two non-targeted data processing approaches: A case study from recirculating aquaculture systems.

BACKGROUND: The accumulation of dissolved organic matter (DOM) poses an issue in the management of the water quality from recirculating aquaculture systems (RAS), but its characterization is often not detailed enough to understand the DOM transformations in RAS. In this study, we investigated the application of two distinct non-targeted data processing approaches using ultra-performance liquid chromatography (UPLC) with quadrupole time-of-flight mass spectrometry (QTOF-MS) and two software with different algorithmic designs: PetroOrg and Progenesis QI to accurately characterize the molecular composition of DOM in RAS by UPLC-QTOF-MS. RESULTS: The UPLC-QTOF-MS resolution in combination with PetroOrg and Progenesis QI software successfully assigned 912 and 106 unique elemental compositions, respectively, including compounds containing carbon, hydrogen, and oxygen (CHO) and nitrogen-containing CHO compounds (CHON), in the DOM samples from RAS. The results of these two distinct data processing approaches were consistent with the list of DOM formulas from RAS identified by higher resolution mass spectrometry techniques confirming their reliability. PetroOrg approach revealed only compositional information in the DOM samples from RAS, while Progenesis QI in addition to identifying new elemental compositions, increased their chemical space by giving information about their polarity and their possible key structures. DOM samples from RAS were found to be rich in unsaturated CHO compounds, with tentatively key structures of terpenoids with medium polarity indicating natural origins in their composition. The analysis also revealed probable structures of sucrose fatty acid esters and polyethylene glycol, indicating anthropogenic sources. SIGNIFICANCE AND NOVELTY: The combination of these two non-targeted data processing approaches significantly improves the characterization of the complex mixture of DOM from RAS by UPLC-QTOF-MS reporting for the first time accurate DOM results in terms of its composition, while proposing its key structures. The presented methods can also be used to analyze different DOM samples with other HRMS techniques and software.

Impact of ozone treatment on dissolved organic matter in land-based recirculating aquaculture systems studied by Fourier transform ion cyclotron resonance mass spectrometry.

In land-based recirculating aquaculture systems (RAS), the accumulation of dissolved organic matter (DOM) can have detrimental effects on water quality impacting the system performance, microbial community, and consequently fish health and welfare. Ozone is used in the RAS water treatment process to improve water quality and remove DOM. However, little is known about the molecular composition of DOM in RAS and its transformation when exposed to ozone. In this study, we performed a detailed molecular characterization of DOM in RAS and explored its transformation induced by ozonation of RAS waters. Ultra-high resolution (UHR) Fourier transform ion cyclotron resonance mass spectrometry (FTICR MS) was used to characterize the DOM matrix of RAS waters (pump-sump and tanks) and to evaluate its transformation by ozonation. The analysis of DOM extracted from makeup water and feed samples allowed for the determination of DOM sources in RAS prior to ozonation. The CHO and unsaturated group of compounds were the most abundant class found in water samples. On the contrary, the DOM from feed samples was unique and consisted mainly of CHO, CHON and unsaturated group of compounds. After the ozonation of RAS waters, humic-like and unsaturated compounds [positive oxygen subtracted double bond equivalent per carbon (DBE-O)/C)] were decomposed, particularly the CHO-DOM that contained fewer -CH2- features. Fulvic-like compounds and several hundred saturated compounds [negative (DBE-O)/C)] were formed post ozonation, particularly the CHON and CHONS group of compounds that were associated with fish diets, makeup waters and transformation products from the ozonation of the RAS waters. This study showed that the high accuracy of the ultra-high resolution FTICR MS can be applied to characterize and monitor the changes of DOM at a molecular level in RAS waters. To our knowledge, this is the first study where FTICR MS was incorporated for the characterization of DOM and its sources in RAS.

Characterizing changes of dissolved organic matter composition with the use of distinct feeds in recirculating aquaculture systems via high-resolution mass spectrometry.

Recirculating aquaculture systems (RAS) are a new alternative to traditional aquaculture approaches, allowing full control over the fish production conditions, while reducing the water demand. The reduction of water exchange leads to an accumulation of dissolved organic matter (DOM) that can have potential effects on water quality, fish welfare and system performance. Despite the growing awareness of DOM in aquaculture, scarce scientific information exists for understanding the composition and transformation of DOM in RAS. In this study, a non-targeted approach using ultra-performance liquid chromatography coupled to a hybrid quadrupole-time of flight mass spectrometer (UPLC-QTOF-MS) was used to characterize compositional changes of low molecular weight (LMW) DOM in RAS, when operated under two different feed types. A total of 1823 chemicals were identified and the majority of those contained a CHON chemical group in their structure. Changes in the composition of LMW-DOM in RAS waters were observed when the standard feed was switched to RAS feed. The DOM with the use of standard feed, consisted mainly of lignin/CRAM-like, CHO and CHOS chemical groups, while the DOM that used RAS feed, was mainly composed by unsaturated hydrocarbon, CHNO and CHNOS chemical groups. The Bray-Curtis dissimilarity cluster demonstrated differences in the composition of DOM from RAS and was associated to the type of feed used. When the RAS feed was used, the Kendrick mass defect plots of -CH2- homologous units in the pump-sump (after the water treatment) showed a high removal capacity for CHNO, CHNOS and halogenated chemicals with high Kendrick mass defect, KMD > 0.7. To our knowledge, this is the first report of LMW-DOM characterization of RAS by high-resolution mass spectrometry (HRMS).

The dissemination of knowledge / La difusión del conocimiento

Writing content regarding the progress of medical knowledge demands the adherence to recommended practices in scientific research. It also requires clear communication, choosing the most fitting journal for its review, and observing author's instructions in order to enable its publication.

Escribir contenidos acerca del avance en el conocimiento de la medicina, exhorta el ejercicio de las prácticas recomendadas en la investigación de carácter científico, además reclama una comunicación clara y elegir la revista más adecuada para su revisión, con la debida atención a sus instrucciones para autores, así se favorece su publicación.

[Communication, knowledge and medicine]. / Comunicación, conocimiento y medicina.

Knowledge developed by humanity has had profound transcendence concerning its communication and preservation. An example of this are the advances in explanations regarding health and disease, whose mainly printed circulation is rapidly losing its place to digital publications. That is the way it happens with the Revista Médica del Instituto Mexicano del Seguro Social, whose aim is the same: to disseminate new knowledge.

El conocimiento generado por la humanidad ha tenido profunda trascendencia en la medida de su comunicación y preservación. Un ejemplo son los avances en las explicaciones en torno a la salud y la enfermedad, cuya difusión mayormente impresa, cede vertiginosamente el lugar a la publicación electrónica. Así ocurre con la Revista Médica del Instituto Mexicano del Seguro Social, sin cambiar su finalidad: propagar nuevo conocimiento.

Barriers to Follow-Up for Abnormal Papanicolaou Smears among Female Sex Workers in Lima, Peru.

BACKGROUND: Cervical cancer is the most prevalent cancer among Peruvian women. Female sex workers (FSW) in Peru are at elevated risk for HPV infection, and receive annual Papanicolaou screening. The objective of this study was to identify barriers to follow-up for abnormal Pap smears among FSW in Peru. METHODS: 97 FSW attending the Alberto Barton Health Center in Lima were surveyed regarding their STI screening history. 17 women with a history of an abnormal Pap smear were interviewed about their experiences regarding follow-up care. RESULTS: Of the 27 HPV-positive women, only 8 (30%) received follow-up treatment. Of the 19 women who did not receive follow-up, 7 (37%) had not been informed of their abnormal result. Qualitative interviews revealed that the major barrier to follow-up was lack of knowledge about HPV and potential health consequences of an abnormal Pap smear. CONCLUSION: HPV infection is highly prevalent in Peruvian FSW, yet only 30% of FSW with abnormal Pap smears receive follow-up care. The predominant barriers to follow-up were lack of standardization in recording and communicating results and insufficient FSW knowledge regarding health consequences of HPV infection. Standardization of record-keeping and distribution of educational pamphlets have been implemented to improve follow-up for HPV.

[Adaptation and validation of scales to measure self-efficacy and empowerment for self-care in Mexican climacteric stage women]. / Adaptación y validación de escalas de autoeficacia y empoderamiento dirigidas a mujeres mexicanas en etapa de climaterio.

OBJECTIVE: To adapt and validate in Spanish of Mexico scales to measure self-efficacy (SES) and empowerment for self-care (ES) among climacteric women. MATERIALS AND METHODS: The study was conducted from February to July 2011 in two family medicine clinics in Mexico City. The adaptation phase was done through testing for language comprehension. To validate the scales we used the principal Axis factoring analysis with oblique rotation technique and estimation of Cronbach's alpha (CA). RESULTS: Three hundred eighty women aged 45-59 years participated in the study. SES had 16 items with four factors: participation in the doctor-patient relationship; in the study control of mental health and sexual changes; risk of dying from cancer, and other health risks that explained 39.8% of the variability, CA = 0.84. ES had eight items with one factor explaining 47.1% variability; CA = 0.83. CONCLUSION: Both scales had acceptable psychometric properties and are suitable for interventions aimed at improving self-care of climacteric women.

Adaptación y validación de escalas de autoeficacia y empoderamiento dirigidas a mujeres mexicanas en etapa de climaterio / Adaptation and validation of scales to measure self-efficacy and empowerment for self-care in Mexican climacteric stage women

OBJETIVO: Adaptar y validar en español de México dos escalas: autoeficacia (EAE) y empoderamiento (EE) durante el climaterio. MATERIAL Y MÉTODOS: El estudio se realizó de febrero a julio de 2011, en dos clínicas de medicina familiar en la Ciudad de México. Adaptación a través de pruebas piloto para comprensión lingüística; validación de constructo mediante análisis de factores con factorización del eje principal y rotación oblimin; estimación de la consistencia interna mediante alfa de Cronbach (AC). RESULTADOS: Participaron 380 mujeres de 45 a 59 años. EAE tenía 16 reactivos con cuatro factores: participación en la relación médico-paciente; control sobre salud mental y cambios sexuales; riesgo de morir de cáncer y otros riesgos de salud, que explicaron 39.8% de variabilidad; AC= 0.84. EE: ocho reactivos con un factor que explicó 47.1% de variabilidad; AC= 0.83. CONCLUSIÓN: Ambas escalas poseen características psicométricas aceptables para utilizarlas en intervenciones para mejorar el autocuidado de la salud durante el climaterio.

OBJECTIVE: To adapt and validate in Spanish of Mexico scales to measure self-efficacy (SES) and empowerment for self-care (ES) among climacteric women. MATERIALS AND METHODS: The study was conducted from February to July 2011 in two family medicine clinics in Mexico City. The adaptation phase was done through testing for language comprehension. To validate the scales we used the principal Axis factoring analysis with oblique rotation technique and estimation of Cronbach's alpha (CA). RESULTS: Three hundred eighty women aged 45-59 years participated in the study. SES had 16 items with four factors: participation in the doctor-patient relationship; in the study control of mental health and sexual changes; risk of dying from cancer, and other health risks that explained 39.8% of the variability, CA= 0.84. ES had eight items with one factor explaining 47.1% variability; CA= 0.83. CONCLUSION: Both scales had acceptable psychometric properties and are suitable for interventions aimed at improving self-care of climacteric women.

Integrative health care model for climacteric stage women: design of the intervention.

BACKGROUND: Climacteric stage women experience significant biological, psychological and social changes. With demographic changes being observed in the growing number of climacteric stage women in Mexico, it is important to improve their knowledge about the climacteric stage and its potential associated problems, encourage their participation in screening programs, and promote the acquisition of healthy lifestyles.At Mexican health care institutions the predominant health care model for climacteric stage women has a biomedical perspective. Medical doctors provide mostly curative services and have limited support from other health professionals. This study aims to design an integrative health care model (IHCM: bio-psycho-social, multidisciplinary and women-centered) applicable in primary care services aimed at climacteric stage women. METHODS/DESIGN: We present the design, inclusion criteria and detailed description of an IHCM. The IHCM consists of collaborative and coordinated provision of services by a health team, which is involves a family doctor, nurse, psychologist, and the woman herself. The health team promotes the empowerment of women through individual and group counseling on the climacteric stage and health related self-care. The intervention lasts three months followed by a three-month follow-up period to evaluate the effectiveness of the model. The effectiveness of the model will be evaluated through the following aspects: health-related quality of life (HR-QoL), empowerment, self-efficacy and knowledge regarding the climacteric stage and health-related self-care activities, use of screening services, and improvement in lifestyles (regular leisure time physical activity and healthy diet). DISCUSSION: Participation in preventive activities should be encouraged among women in Mexico. Designing and evaluating the effectiveness of an integrative health care model for women at the climacteric stage, based on the empowerment approach and focus on health-related self-care to improve their HR-QoL is pertinent for current health conditions of this age group. TRIAL REGISTRATION: The study is registered at the ClinicalTrials.gov (NCT01272115).

Social network types and functional dependency in older adults in Mexico.

BACKGROUND: Social networks play a key role in caring for older adults. A better understanding of the characteristics of different social networks types (TSNs) in a given community provides useful information for designing policies to care for this age group. Therefore this study has three objectives: 1) To derive the TSNs among older adults affiliated with the Mexican Institute of Social Security; 2) To describe the main characteristics of the older adults in each TSN, including the instrumental and economic support they receive and their satisfaction with the network; 3) To determine the association between functional dependency and the type of social network. METHODS: Secondary data analysis of the 2006 Survey of Autonomy and Dependency (N = 3,348). The TSNs were identified using the structural approach and cluster analysis. The association between functional dependency and the TSNs was evaluated with Poisson regression with robust variance analysis in which socio-demographic characteristics, lifestyle and medical history covariates were included. RESULTS: We identified five TSNs: diverse with community participation (12.1%), diverse without community participation (44.3%); widowed (32.0%); nonfriends-restricted (7.6%); nonfamily-restricted (4.0%). Older adults belonging to widowed and restricted networks showed a higher proportion of dependency, negative self-rated health and depression. Older adults with functional dependency more likely belonged to a widowed network (adjusted prevalence ratio 1.5; 95%CI: 1.1-2.1). CONCLUSION: The derived TSNs were similar to those described in developed countries. However, we identified the existence of a diverse network without community participation and a widowed network that have not been previously described. These TSNs and restricted networks represent a potential unmet need of social security affiliates.

Impactos urbano ambientales en la margen derecha del río Chillón / Urban - environmental impacts on the right bank of the Chillón river

El proceso de crecimiento urbano de las ciudades, con su inevitable ocupación urbana, trae consigo el deterioro de las condiciones ambientales de sus territorios urbanos y rurales. Se debe entender a las ciudades como el lugar de crecimiento demográfico actividad comercial e industrial, por tanto concentran el uso de energía y recursos y la generación de desperdicios llegando a impactar y sobrecargar el medio ambiente urbano. Entendamos al Medio Ambiente Urbano como el ámbito espacial tridimensional donde interaccionan factores naturales, sociales y obras construidas por el hombre, formando un sistema global dinámico que integra también al territorio del medio urbano. El presente artículo se basa en la identificación crítica sobre los impactos urbanos ambientales resultado del recorrido e inspección visual sobre la margen derecha del río Chillón, donde la población viene desempeñando décadas atrás, algunas ocupaciones urbanas, quienes en un primer caso por la morfología del terreno se han asentado irregularmente, ocupando zonas inestables de los terrenos, con graves riesgos y alta vulnerabilidad; en un segundo caso han tenido cierta capacidad de organización social, ocupando el terreno de manera regular, como consecuencia espacios urbanos visualmente, repetitivos, monótonos, lineales y con poco atractivo escénico, que se les promisora en el futuro, se conviertan en espacios urbanos sin calidad, en ambos casos transformando grandes extensiones de espacios naturales y convirtiéndolos en espacios urbanos, carentes de servicios básicos. El recorrido realizado sobre la margen derecha del río Chillón, corresponde a la delimitación política de los distritos del Callao y San Martin de Porres, de la cuidad de Lima- Perú. Se inició la identificación de los impactos urbanos ambientales desde el puente del Río Chillón con la intersección de la Av. Gambeta, el estado de contaminación en que se encuentran las aguas y el paisaje del Rió chillón es muy grave...

This process of urban development of the cities. With its inevitable urban settlement, causes deterioration of the environmental conditions in its rural and urban territories. Cities are to be considered as the place of demographic development, commercial and industrial activity; then, they concentrate the use of energy and resources as well as waste production, making impact on and overloading urban environment. Let understand Urban Environment as the three-dimensional space where natural, social factors and works built by man interact, forming a dynamic global system which also integrates the territory o urban environment. This paper is based on the identification and critic of urban – environment impacts resulting from the visit and visual inspection made to the right bank of the Chillón River, where the population has settled decades ago. In one case, due to the terrain morphology, they have settled irregularly, occupying instable zones, with severe risks and high vulnerability. In other case, they have had some social organization capacity, occupying the zone regularly, resulting in urban spaces which are visually repeated, monotonous, lineal and not very attractive in scene; then, they are forecast to become urban spaces without quality, in both cases turning wide natural spaces into urban spaces, lacking utilities. The visit to the right bank of the Chillón River includes the district political division of Callao and San Martín de Porres, from the city of Lima – Peru. The identification of urban-environmental impacts started from the Chillón river bridge at intersection with Gambeta Avenue: pollution level of water and the Chillón River scenery is very high. Therefore, this paper pretends to use the pictures taken to call to reflection and ask ourselves, what are we doing for our urban environment sustainability?-taking into account that the concept of sustainable city is old, but must be used to create a change of mind related...

[Teaching practices and the position concerning medical education]. / La práctica docente y la postura ante la educación médica.

OBJECTIVE: Estimate the degree of development of a position concerning medical education, in a phisician population. METHODS: We carried out a cross-sectional study at with 1580 physicians; we selected 395 participants by non-proportional stratified sampling of an IMSS health facility; 244 (62 %) was medical professors, included 15 physicians responsible for education. A previously validated instrument was applied to these participants. Three indicators were evaluated: agreement in general, most popular trend, and consequence. Group grading was done blindly. Kuder-Richardson test was utilized to calculate the value of internal instrument consistency and nonparametric statistics < 0.05. RESULTS: Answering tendency in agreement were similar among physicians; heads or managers were statistically significant. The most popular trend was participative. In terms of consequence in physicians, there were some without consequent sentences in pair. CONCLUSIONS: The most popular trend was participative, although it would appear that this has not been pondered, in that on exploring the indicator, that of consequence. Teaching practices do not have any significant influence on the development of a position concerning medical education.

[Achieving an educative strategy in undergraduate medical interns with respect to patients with diabetes]. / Alcances de una estrategia educativa frente a pacientes diabéticos en estudiantes de medicina internos de pregrado.

OBJECTIVE: To estimate the achievement of an educative strategy that promoted participation of the development of the clinical aptitude of undergraduate medical students with regard to patients with diabetes. MATERIALS AND METHODS: We conducted a quasi-experimental study with two groups of undergraduate medical students. We validated an instrument to explore clinical attitude concerning diabetes mellitus (ACDIME) with 30 items for each of six indicators. The instrument was applied at two general hospitals, before and after carrying out the educative strategies. In the experimental group, we conducted an educative strategy that promotes participation in developing clinical aptitude, while the customary strategy was developed in the control group. RESULTS: ACDIME consistency was 0.80. Both study groups were similar before the educative strategies (p = 0.165). Statistically significant differences existed after the strategies in all indicators were evaluated, in favor of the experimental group. The tendency to change, with a criterion of 50% or more, was only statistically significant in the experimental group (p < 0.0001). CONCLUSIONS: The ACDIME instrument is valid and reliable. The educative strategy that promoted participation is clearly superior to the customary strategy with regard to achievement.

Aptitudes clínicas en alumnos de cursos postécnicos de enfermería pediátrica / Clinical aptitudes in students of post-technical pediatric nursing courses

Introducción: Uno de los fines de la investigación educativa es conocer los resultados del proceso de formación, como lo es el curso postécnico de enfermería pediátrica del Instituto Mexicano del Seguro Social (IMSS). Esta aproximación se realizó bajo un enfoque participativo de la educación. Objetivo: Estimar el grado de desarrollo de las aptitudes clínicas en los alumnos de los cursos postécnicos de enfermería pediátrica del IMSS. Metodología: Estudio descriptivo, transversal, comparativo con un censo de 62 alumnos. Se validó un instrumento con casos clínicos para explorar el desarrollo de aptitudes clínicas de los alumnos en el cuidado de pacientes pediátricos. Resultados: No se encontró ninguna diferencia estadísticamente significativa comparando las tres sedes del curso. El grado de desarrollo de las aptitudes clínicas de los alumnos resultó de muy bajo a bajo. Los indicadores con menor dominio fueron valoración de enfermería e integración diagnóstica. Conclusiones: El curso no parece tener influencia sobre un desarrollo aceptable de aptitudes clínicas de los alumnos en el cuidado del paciente pediátrico. Se hacen sugerencias para mejorar la forma de acercarse a los contenidos teóricos y prácticos, durante el curso postécnico de enfermería pediátrica.

Introduction: One of the objectives from the educational research is to know the results of the edifying process as in the Post-technical Pediatric Nursing Course from Instituto Mexicano del Seguro Social (IMSS). This approach was done under a participative focus of education. Objective: To estimate the level of development of clinical aptitudes in students from Post-technical Pediatric Nursing Course from IMSS. Methodology: Descriptive, transversal, and comparative study with 62 students. An instrument was validated with clinical cases to explore the development of clinical aptitudes in students who were taking care of pediatric patients. Results: It was not found any statistically significant difference among the three courses took place. The level of development of clinical aptitudes in students resulted from too low to low. Indicators with less dominance were nursing assessment and diagnostic integration. Conclusions: The course is not alike to have an influence over an acceptable development of clinical aptitudes in students who care pediatric patients. Suggestions are made to improve the way to get close to the practical and theoretical contents during the Post-technical Pediatric Nursing Course.

¿El dominio de la lectura crítica va de la mano con la proximidad a la investigación en salud? / Critical reading skill goes along with the proximity to health research?

Objective. The evaluation of a reading skill to critically read theoretical texts, interpretation; at different groups linked to investigation and, explore if a closer, longer experience with this, can influence this skill development. Material and methods. An instrument that comprises a text on epistemologic aspects and the relation of science with society, was validated. It was applied on four natural groups, selected by a degree of involvement they had shown in health research: students at "pre-degree" (n = 23); students at post-degree (n = 19), academic administrative assessors (n = 17), and professional researchers (n = 20). Results. Reliability coeficients of the instrument were 0.91 y 0.94. From 74 as maximum score expected, medians of groups were 19 for pre-grade and post-grade students, 17 for assessors, and 21 for researchers (p = 0.50). Conclusions. The not sufficient ability to critically read a text, that we supposed was more or lest related to all studied groups, come to be highly relevant, when a need for the researcher to acquire plain understanding, of the importance of his actions is acknowledged. And on the other hand, the fact that students on upper levels, be conscious of the reason why science is beforehand included in their education.

Objetivo. Valorar una habilidad propia de la lectura crítica de textos teóricos, la interpretación; en distintos grupos vinculados con la investigación y explorar si una experiencia más cercana y prolongada con ésta, se relaciona con el desarrollo de esa habilidad. Material y métodos. Se validó un instrumento que contiene un texto sobre aspectos epistemológicos y la relación de la ciencia con la sociedad. Se aplicó en cuatro grupos naturales, escogidos por el grado en que aparentemente se habían involucrado con la investigación en salud: estudiantes de pregrado (n = 23); estudiantes de posgrado (n = 19), asesores académico-administrativos (n = 17) e investigadores profesionales (n = 20). Resultados. Los coeficientes de confiabilidad del instrumento fueron de 0.91 y 0.94. De una puntuación máxima esperada de 74, las medianas de los grupos fueron: 19 para los estudiantes de pregrado y de posgrado, 17 para los asesores y 21 para los investigadores (p = 0.50). Conclusiones. La insuficiente habilidad para interpretar un texto con una temática que supusimos más o menos de interés para los grupos estudiados, toma gran relevancia cuando se reconoce la necesidad de que el investigador adquiera plena conciencia de la trascendencia de sus acciones. Y, por otra parte, el que los estudiantes de nivel superior también sean conscientes del porqué se antepone la ciencia en su formación.

[Critical reading skill goes along with the proximity to health research?]. / El dominio de la lectura crítica va de la mano con la proximidad a la investigación en salud?

OBJECTIVE: The evaluation of a reading skill to critically read theoretical texts, interpretation; at different groups linked to investigation and, explore if a closer, longer experience with this, can influence this skill development. MATERIAL AND METHODS: An instrument that comprises a text on epistemologic aspects and the relation of science with society, was validated. It was applied on four natural groups, selected by a degree of involvement they had shown in health research: students at "pre-degree" (n = 23); students at post-degree (n = 19), academic administrative assessors (n = 17), and professional researchers (n = 20). RESULTS: Reliability coeficients of the instrument were 0.91 y 0.94. From 74 as maximum score expected, medians of groups were 19 for pre-grade and post-grade students, 17 for assessors, and 21 for researchers (p = 0.50). CONCLUSIONS: The not sufficient ability to critically read a text, that we supposed was more or lest related to all studied groups, come to be highly relevant, when a need for the researcher to acquire plain understanding, of the importance of his actions is acknowledged. And on the other hand, the fact that students on upper levels, be conscious of the reason why science is beforehand included in their education.

Competencia clínica en hipertensión arterial sistémica de alumnos de pregrado de dos escuelas de medicina / Clinical competence in hypertensive vascular disease of medical students of two universities

Objetivos. A) Construir y validar un cuestionario para explorar la competencia clínica de estudiantes de medicina en hipertensión arterial sistémica (HAS). B) Conocer y comparar la competencia clínica de los alumnos de medicina de dos universidades, próximos a brindar atención a los pacientes con HAS. Diseño. Estudio transversal. Métodos. Se elaboró un cuestionario con casos clínicos reales y 150 reactivos que exploran habilidades clínicas, fue validado por expertos que laboran en hospitales que pertenecen al IMSS. Se aplicó el cuestionario a estudiantes de dos escuelas de medicina a punto de egresar. Resultados. Obtuvimos un coeficiente por prueba de Kuder-Richardson de 0.89. Hubo diferencias estadísticamente significativas entre los dos grupos de estudiantes en las puntuaciones globales a expensas de tres de los nueve indicadores explorados. Del grupo 1, 94 por ciento de los estudiantes tuvieron competencia clínica baja y muy baja; del grupo 2, 87 por ciento intermedia y baja. Al analizar los reactivos correspondientes al indicador tratamiento no hubo diferencias estadísticamente significativas y casi todos los estudiantes se situaron en competencia clínica baja y muy baja o como si no hubieran estudiado medicina. Conclusiones. Se considera que el cuestionario es válido y confiable. La competencia clínica en los estudiantes incluidos es deficiente para resolver adecuadamente los casos presentados. Es probable que la atención que otorgarán a los pacientes hipertensos sea inadecuada por lo que es insoslayable mejorar la competencia clínica de los que laborarán como médicos generales, al menos durante el año del servicio social.

Dos estrategias educativas en el manejo de pacientes con diálisis peritoneal intermitente / Two educational strategies in patients with intermittent peritoneal dialysis

En este trabajo se comparan los efectos de dos estrategias educativas tendentes a incrementar la competencia clínica de la enfermera ante pacientes con diálisis peritoneal intermitente Se realizó un diseño cuasi experimental con dos grupos de estudio. En uno se utilizó una estrategia habitual de tipo expositivo (EHE) y en el otro una estratega promotora de la participación (EPP) o experimental. A todos los participantes se les efectuaron mediciones basares y finales con un instrumento construido exprofeso. Las mediciones básales permitieron apreciar la similitud de ambos grupos en relación con los tres indicadores con que se midió la competencia clínica En cada grupo hubo un incremento significativo: EHE de 34.0 a 42.8 (p-:0.05) y EPP de 31.8 a 39.8 (p-:0.01), sin diferencias entre ambos después de las intervenciones educativas La efectividad de las estrategias resultó semejante. Se hacen diversas consideraciones acerca de los obstáculos que enfrenta una estrategia educativa promotora de la participación de los alumnos.

The effect of two educational strategies that tend to increase the clinical competence of the nurse who treats patients with intermittent peritoneal dialysis are compared in this work. A quasi-experimental study was performed in two groups. In one group the usual expository type strategy was utilized (ETS). In the other group an experimental strategy that promotes participation (SPP) was used. Basal and end measurements were taken to all participants using an instrument especially designed for that purpose. Basal measurements allowed us to observe the similarity of both groups with respect to the three indicators used to measure clinical competency. There were significant increments in both groups: ETS from 34.0 to 42.8 (p< 0.05) and SPP from 31.8 to 39.8 (p< 0.01), with no difference between both groups after the educational interventions. The effectiveness of both strategies was similar. Several considerations are made concerning the difficulties confronted by an educational strategy that seeks to promote student participation.

Persistencia del aprendizaje de lectura crítica en médicos residentes / Persistence of critical reading o research articles by medical residents

Objetivos. 1. Evaluar la persistencia del aprendizaje adquirido por médicos residentes en un curso de lectura crítica de artículos médicos, tomado siete meses antes. 2. Comparar la persistencia de acuerdo al tipo de entrenamiento recibido (participativo vs expositivo). Métodos. Usamos los mismos grupos de residentes de primer año del estudio previo. Siete meses antes habían recibido un curso de 30 horas de lectura crítica de artículos de investigación: el grupo I (N=28) recibió curso de participación activa con lectura de artículos previos a reuniones de discusión de dichos artículos; el II (N=17) recibió curso expositivo impartido por investigadores activos; el III (N=23) fue igual al II pero con profesores no investigadores. Se utilizó un instrumento desarrollado y validado por nosotros para calificar a los cursillistas sobre su capacidad de leer artículos de investigación inmediatamente después de terminar el curso (puntaje inicial) y fueron vueltos a medir siete meses después (puntaje diferido). No todos fueron vueltos a medir: faltaron dos en los grupos I y III, y seis en el II. Se usaron métodos no paramétricos en las comparaciones (Wilcoxon, Kruskal-Wallis, Mann-Whitney). Resultados. No hubieron diferencias intragrupos entre las medianas inicial y diferida (17.5 diferida vs 19 inicial en grupo I, 7 vs 13 en grupo II, y 6 vs 3 en grupo III). En el estudio inicial, sólo el grupo III fue inferior a los otros, pero en el diferido, el grupo I fue el único superior a los otros (p<0.006). Conclusión. El entrenamiento de participación activa para mejorar la lectura crítica fue mejor que los métodos tradicionales que todavía son muy usado en México