[Use of neurodevelopmental disorder screening tool in primary care : A multicenter observational study]. / Utilisation en soins primaires d'un outil de repérage des troubles du neurodéveloppement : étude multicentrique observationnelle.

INTRODUCTION: Neurodevelopmental disorders (NDD) affect 5 to 15% of the population. Improved management largely depends on early detection in primary care. A screening tool was developed by an expert consensus and its use has been recommended since 2019. This tool has never been evaluated to date. The aim of this study was to investigate the prevalence and factors associated with the identification of neurodevelopmental disorders in primary care in children aged 6 months to 5 years. METHOD: This work is a multicentric observational study carried out in general practice in two regions of France: Île-de-France and Auvergne-Rhône-Alpes. A multivariate analysis was performed to identify the factors associated with the presence of abnormal signs on the grid. RESULTS: Five hundred and sixty-four (564) children aged 6 months to 4 years were included. The prevalence of children identified on the grid was 3.9%. The factors associated with the neurodevelopmental disorders identified in multivariate analysis were: low socio-professional status of the mother, male gender and parental concern about the child's neurodevelopment. Factors associated with identifying a developmental trajectory gap were male gender (OR = 2.10 (1.22-3.62)) and low socio-professional status of the mother (OR = 2.23 [1.05-4.70]). CONCLUSION: This original work allowed us to carry out first-line testing of a tool for the identification of NDD in primary care and to evaluate the prevalence of identification of these disorders. A complementary cohort study will be necessary to evaluate the sensitivity and specificity of this identification tool.

[Association between students' clinical performance and their success in the computerized national ranking tests: A single-center retrospective cohort study]. / Association entre les performances cliniques des étudiants et leur réussite aux Épreuves classantes nationales informatisées : une étude de cohorte rétrospective monocentrique.

INTRODUCTION: Before attending residency, 6th-year French medical students must validate a final examination including a practical clinical test in their faculty. However, the national ranking that determines their future specialty and region solely relies on a computerized knowledge test. Our goal was to investigate the association between the final faculty test and the national ranking test. METHODS: In our faculty, the final examination includes a computerized theoretical test (similar to the national one) and a practical test: a standardized evaluation of semiology skills at the bedside and a standardized assessment of relational skills with role plays. The agreements between the national test and faculty computerized and practical tests were analyzed by intraclass correlation coefficients (ICC). RESULTS: Data from 1806 students who underwent the three examinations from 2017 to 2021 were analyzed. There was a good agreement between the ranks in the faculty and national computerized tests: ICC 0.83 (95% CI 0.81-0.85). By contrast, the agreement between the ranks in the faculty practical test and the national computerized test was poor: ICC 0.13 (95% CI 0.08-0.17). Results were stable over the years. CONCLUSION: The agreement between the ranking of the current national test and the clinical skills assessed by a specific faculty test is poor. This could relate to a true independence or to different levels of motivation to perform well. Indeed, the result of the national test is the most important one as it determines their career. Incorporating a clinical assessment into the national ranking test will motivate students to acquire clinical skills and value those who perform well this practical dimension.

[Screening and healthcare for pregnant women with psycho-social vulnerability : A French national study]. / Dépistage et parcours de soins en cas de vulnérabilités psycho-sociales maternelles : une enquête nationale française.

INTRODUCTION: Psycho-social vulnerabilities are a medical risk factor for both fetus and mother. Association between socioeconomic status and prenatal follow-up has been well established and inadequate follow-up is associated with higher morbidity and mortality in women in unfavorable situations. OBJECTIVE: The objective is to identify screening strategies and to describe existing systems for pregnant women in psycho-social vulnerability in French maternity hospitals. MATERIAL AND METHODES: This is a national survey conducted by questionnaire in all French maternities. RESULTS: Screening by means of targeted questions is carried out by 96.7% of maternity units. Early prenatal interviews are offered systematically by 64% of maternity units and access to them is still difficult for women in vulnerable situations. In order to organize care pathways, 28.7% of maternities have a structured unit within their establishment and 81% state that they have mobilizable caregivers. Multidisciplinary meetings for the coordination of the various stakeholders are held by 85.8% of maternity units. Collaboration with networks and associations is emphasized. CONCLUSION: A large proportion of maternities seek to identify women in situation of psycho-social vulnerabilities and to organize care paths. However, the resources implemented still appear insufficient for many maternity units. Each maternity hospital has resources and is developing initiatives to deal with the difficulties of care.

Screening for active and latent TB among migrants in France.

SETTING: Migrants to Europe face a disproportionate burden of infections, including TB, yet little is known about the approach taken by primary and secondary care providers to screening and treatment. We therefore explored policy and practice relating to screening of active TB and latent TB infection (LTBI) in France.METHODS: We conducted an online national survey of French primary and secondary care physicians regarding their practices in relation to TB/LTBI screening among migrants.RESULTS: 367 physicians responded to the questionnaire among which 195 (53.1%) were primary care physicians, 126 (34.3%) were TB specialists in secondary care, and 46 (12.5%) other physicians; 303 (85.5%) were involved daily in the care of migrants. Most respondents recommended systematic TB screening with chest X-ray for migrants from medium and high-incidence countries (71.9%). Primary care physicians were less likely to offer screening than physicians in other settings (aOR 0.21, 95% CI 0.09-0.48). 220 (61.8%) offered LTBI screening for children (<15 years) and 34.0% for all migrants from high incidence countries.CONCLUSION: Improving awareness on TB screening is a critical next step to improve health outcomes in migrant groups and meet regional targets for tackling TB.

Microbiological evaluation of combined advanced chemical-biological oxidation technologies for the treatment of cork boiling wastewater.

This paper contains a multidisciplinary approach that will contribute to design and properly evaluate a treatment line for complex biorecalcitrant wastewaters. To demonstrate this approach a specific industrial wastewater (cork boiling wastewater, CBW) was used. A treatment line based on a coagulation-flocculation step followed by an Advanced Oxidation Process (AOP) (solar photo-Fenton) and combined with an aerobic biological system was evaluated. Applied microbiological techniques: optical microscopy, plate count, DNA extraction and qPCR, indicated that some communities disappeared after the activated sludge adaptation period to the partially treated wastewater, while communities that did not disappear were damaged: 2-log reduction of total heterotrophic bacteria (THB) and a decrease in DNA concentration from 200 ng/µL to 65 ng/µL were observed. Therefore, chemical and microbiological results obtained along the set of experiments, suggested the inefficiency of the combined treatment option between solar photo-Fenton and advanced aerobic biological systems for CBW. This led to the necessity of applying solar photo-Fenton without combining with biotreatment and with the objective of improving the effluent quality enough for being reused in the own industry. Toxicity tests, based on different organisms (after coagulation-flocculation followed by solar photo-Fenton), showed increase on acute toxicity (from 46% to 71% by respirometric assays) and the development of chronic toxicity (from 21-29% to 83-90% also measured by respirometric assays), made evident the incompatibility of this type of wastewater with a biological treatment even after the application of an AOP.

Kinetic assessment of antibiotic resistant bacteria inactivation by solar photo-Fenton in batch and continuous flow mode for wastewater reuse.

The presence of antibiotic resistant bacteria in municipal wastewater treatment plants represents a real risk to human health. For the first time, this paper shows that the inactivation rate of cefotaxime resistant bacteria is the same as total bacteria when secondary effluents are treated by the solar photo-Fenton process. To obtain this result, an exhaustive and comparative kinetic study on the inactivation of both total and cefotaxime resistant bacteria (Total coliform, Escherichia coli and Enterococcus sp) was carried out, taking into account the effects of the main operation conditions, such as solar irradiance and iron concentration, and operation mode (batch and continuous). In all the operation conditions studied, no significant differences were found between the first order inactivation rate constants, ki, of total and cefotaxime resistant bacteria. Additionally, ki increased with solar irradiance and iron concentration. As for the effect of the operation mode, the main finding of this work is much quicker inactivation in continuous flow mode than in batch mode, pointing out its potential application at large scale. The best continuous operation condition to inactivate the bacteria to the detection limit (1 CFU mL-1), was at 22.4 min of hydraulic residence time with 5 mg Fe2+ L-1 and 30 mg H2O2·L-1. This treatment time is approximately a third of that reported in batch mode. The efficiency, in terms of figure of merits, of the continuous flow operation was 2.7 m2 of solar collector area to reduce one log of E. coli concentration per m3 of treated water and per hour, in comparison with 2137 m2 calculated for batch operation under the same solar UVA irradiance, 30 W m-2. This paper encourages research into continuous solar disinfection processes due to its enhanced efficiency with regard to the commonly used batch wise operation and shows that efficient removal of total bacteria ensures the removal of antibiotic resistant bacteria.

A new method for characterization of small capacity wind turbines with permanent magnet synchronous generator: An experimental study.

This work presents a new and useful method to dimension wind turbines and control systems and to optimize their mechanical design. This method allows determining the principal curves for characterizing a small capacity wind turbine designed with a Permanent Magnet Synchronous Generator (PMSG). For the wind turbine characterization it was considered the losses in the process of energy transformation in the wind rotor, electric generator and in the bridge rectifier. The equivalent electric model of the synchronous generator was used to determine the electric parameter performance. The work of the wind rotor was considered in its maximum power curve and the PMSG performance in the linear region of its magnetization curve. This leads to develop a new methodology for the complete wind turbine characterization from the nominal parameters of the wind rotor and the electric generator. This method also allows obtaining the power curves and the parameters of voltage, current and efficiency around the wind speed domain and angular speed in the wind rotor. The method was tested for small-capacity wind turbine (1 kW and 10 kW) performances and the numerical and experimental results are described.

Estudios del laboratorio de diversos parámetros orientados a tratar de dilucidar la fisiopatología del síndrome de ovarios poliquísticos (SOP). Parte 2 / Laboratory studies of several parameters aimed to elucidate the pathophysiology of polycystic ovary syndrome. Second part

RESUMEN Diversos estudios bioquímicos adicionales a la evaluación de Testosterona total (TT), biodisponible (Tbio) y libre (TL) han sido realizados a los efectos que pudieran resultar de mayor utilidad para el diagnóstico de patologías concomitantes en el SOP, entre otros. En la hormona anti Mülleriana, cuando la concentración supera a los 3,0 ng/ml existen evidencias de que el 79% de las mismas pueden ser identificadas correctamente como SOP. El Antígeno Prostático Específico (PSA), marcador de singular importancia en pacientes con cáncer de Próstata, con técnicas ultrasensibles ha podido ser detectado en más del 50% en mujeres. En un grupo de pacientes con SOP, los niveles circulantes de PSA fueron significativamente mayores que en las mujeres sin SOP. El Kiss-1 aislado de la placenta y demostrado en otros tejidos, presenta niveles aumentados que correlacionan con la LH, TT, TL y resistencia a la insulina (RI) en adolescentes con SOP versus adolescentes sin SOP, sugiriendo que el Kiss-1 podría estar involucrado en el desarrollo del SOP en estas pacientes. Algunas pacientes con SOP están asociadas a patologías relevantes, de las cuales han sido comunicadas el aumento del BMI, mayor grado de dislipemia, adiposidad central, RI y Síndrome Metabólico (SMe). En las pacientes con un fenotipo clásico (hiperandrogenismo, alteración del ciclo menstrual y ovarios poliquísticos), estas patologías son de mayor frecuencia y severidad que en los otros fenotipos, particularmente aquellos sin hiperandrogenismo. Otras determinaciones como TNFα, interleuquinas, test de tolerancia a la glucosa, ApoB, partículas pequeñas de LDL e Inhibidor del Activador del Plasminógeno-1 han sido comunicados que podrían ser de utilidad para tener mayor sensibilidad en la definición de patología concomitantes en el SOP. Actualmente se ha comenzado a evaluar otros marcadores como el Fetuin-A; Quemerina, Nesfatina-1, Neopterina y Endocannabinoides, cuyos resultados preliminares parecerían ser un aporte importante para evaluar SMe y RI en paciente con SOP y tratar de definir su prevalencia en los distintos fenotipos de esta patología.

ABSTRACT Several biochemical studies in addition to the evaluation of total Testosterone (TT), bioavailable (bioT) and free (FT) have been performed to the effects that could be of greater use for the diagnosis of concomitant pathologies in the PCOS, among others. The anti-Müllerian hormone whose concentration when exceeds 3.0 ng/ml, there is evidence that 79% of these patients can be correctly identified as PCOS. The Prostate-Specific Antigen (PSA), a marker of singular importance in patients with prostate cancer, with ultra-sensitive techniques, has been detected in more than 50% of women. In a group of patients with PCOS, circulating levels of PSA are significantly higher than in women without PCOS. The Kiss-1 isolated from the placenta and demonstrated in other tissues, has increased levels that correlate with LH, TT, TL and insulin resistance (IR) in adolescents with PCOS respect to adolescents without PCOS, suggesting that Kiss-1 could be involved in the development of the PCOS in these patients. In some patients with PCOS, they are associated with relevant pathologies, of which the increase in BMI, higher degree of dyslipidemia, central adiposity, IR and Metabolic Syndrome (MeS) have been reported. Those that show a classic phenotype (hyperandrogenism, alteration of the menstrual cycle and polycystic ovaries) these characteristics are of greater frequency and severity than in the other phenotypes, particularly those without hyperandrogenism. Other determinations such as TNFα, interleukins, glucose tolerance test, ApoB, small particles of LDL and Plasminogen Activator Inhibitor-1 have been reported that could be useful to have greater sensitivity in the definition of concomitant pathology in the PCOS. Currently, other markers such as Fetuin-A, Chemerin, Nesfatin-1 Neopterin and Endocannabinoids have been evaluated. The preliminary results suggest to be an important contribution to define MeS and IR in patient with PCOS and to try to determine its prevalence in the different phenotypes of this pathology.

Estudios de laboratorio de diversos parámetros orientados a tratar de dilucidar la fisiopatología del síndrome de ovarios poliquísticos. Parte 1 / Laboratory studies of various parameters aimed at trying to elucidate the pathophysiology of polycystic ovary syndrome. Part 1

Esta revisión fue realizada con el fin de evaluar nuestros resultados de laboratorio así como aquellos de la literatura que constituyen, a nuestro entender, aportes significativos en el síndrome de ovarios poliquísticos (SOP). Nuestro especial énfasis será presentar las limitaciones de las metodologías empleadas por nuestro grupo, comparativamente a las reportadas por otros investigadores. La determinación de andrógenos, en particular de Testosterona (TT), es quizá la de mayor complejidad dado que los resultados con los diferentes inmunoensayos empleados en nuestro medio producen resultados muy variables por los diferentes métodos y aún entre laboratorios que usan la misma metodología. La técnica de referencia es la cromatografía líquida en tándem con espectrometría de masa (LC-MSMS), de difícil aplicación en laboratorios de análisis clínicos debido a su alto costo y la imposibilidad de resolver numerosas muestras. En estudios previos demostramos que de los métodos habitualmente usados para evaluar la TT circulante, solo en 2 inmunoensayos los resultados obtenidos fueron satisfactoriamente validados indirectamente según el criterio del Consenso de los Centros para el Control y Prevención de Enfermedades (CDC, USA) contra LC-MSMS, los cuales fueron comparables a dicha metodología con niveles superiores a 0,5 ng/ml. El SOP puede presentar factores de riesgo aumentados para la enfermedad cardiovascular y la diabetes II. Estos factores no están debidamente categorizados en función de los distintos fenotipos del SOP. Se evaluarán los principales analitos empleados con este objetivo y los nuevos que aporten elementos de mayor especificidad en este sentido

This review was performed in order to evaluate our laboratory results as well as those of the literature that constitute, in our opinion, significant contributions in these pathophysiologies. Our special emphasis will be on presenting the limitations of the methodologies used by our group, compared to those reported by other researchers. The determination of androgens, in particular Testosterone (TT), is perhaps the most complex since the results with the different immunoassays used in our environment produce very variable results by the different methods and even between laboratories that use the same methodology. The reference technique is LC-MSMS, difficult to apply in clinical analysis laboratories because of its high cost and the inability to solve numerous samples. In previous studies, we demonstrated that, in comparison to LC-MSMS with the usual methods for evaluating circulating TT, the results obtained in only 2 immunoassays were satisfactorily validated indirectly according to the criteria of CDC against LC-MSMS, which were comparable to that methodology with levels higher than 0.5 ng/ml. PCOS may have increased risk factors for cardiovascular disease and diabetes II. These factors are not properly categorized according to the different phenotypes of PCOS. The main analytes used for this purpose will be evaluated and new ones that contribute elements of greater specificity in this sense

Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study.

BACKGROUND: Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence. METHODS: This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months. RESULTS: The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08-4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64-1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence. CONCLUSIONS: Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.

Factores que afectan al ambiente educativo en la formación preclínica de medicina según sus docentes / Factors affecting the educational environment in undergraduate medical schools

Background: Educational environment has an important effect on the quality of learning and student satisfaction in medicine. Most of previous studies have been conducted using questionnaires that assess the phenomenon considering overall dimensions, without paying attention to the specific manifestations of this topic, especially those aspects that are related to the protagonists of the learning process: teachers and students. Aim: To describe factors that affect the educational environment in the preclinical Medical formation, according to Medical teachers in Concepción, Chile. Material and Methods: Qualitative study, using the Grounded theory method. Semi-structured interviews were performed to 10 medical teachers in Concepcion, Chile. They were selected by theoretical sampling. Data were analyzed using open coding. Results: Four emerging categories about the factors that affect the learning environment were identified: Personal factors of students, academic factors of students, personal factors of teachers and academic factors of teachers. Conclusions: According to interviewed teachers, both personal factors in teachers and students that promote a positive learning environment are related with an attitude oriented towards others and communication skills. Academic factors are related with the responsible exercise of student and teacher roles and with the promotion of participation in the educational process.

[Motivation and self-directed learning among medical students]. / Aspectos motivacionales involucrados en el aprendizaje autodirigido en estudiantes de medicina. Un enfoque cualitativo.

BACKGROUND: Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. AIM: To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. MATERIAL AND METHODS: A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. RESULTS: From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. CONCLUSIONS: Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.

Aspectos motivacionales involucrados en el aprendizaje autodirigido en estudiantes de medicina. un enfoque cualitativo / Motivation and self-directed learning among medical students

Background: Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. Aim: To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. Material and Methods: A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. Results: From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. Conclusions: Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.

[Factors affecting the educational environment in undergraduate medical schools]. / Factores que afectan al ambiente educativo en la formación preclínica de medicina según sus docentes.

BACKGROUND: Educational environment has an important effect on the quality of learning and student satisfaction in medicine. Most of previous studies have been conducted using questionnaires that assess the phenomenon considering overall dimensions, without paying attention to the specific manifestations of this topic, especially those aspects that are related to the protagonists of the learning process: teachers and students. AIM: To describe factors that affect the educational environment in the preclinical Medical formation, according to Medical teachers in Concepción, Chile. MATERIAL AND METHODS: Qualitative study, using the Grounded theory method. Semi-structured interviews were performed to 10 medical teachers in Concepcion, Chile. They were selected by theoretical sampling. Data were analyzed using open coding. RESULTS: Four emerging categories about the factors that affect the learning environment were identified: Personal factors of students, academic factors of students, personal factors of teachers and academic factors of teachers. CONCLUSIONS: According to interviewed teachers, both personal factors in teachers and students that promote a positive learning environment are related with an attitude oriented towards others and communication skills. Academic factors are related with the responsible exercise of student and teacher roles and with the promotion of participation in the educational process.

A Comparison of Serum Testosterone (T) Measurements by Various Methods, Employing Current Validated Techniques or Otherwise, and Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS): A Multicentric Study / Comparación de los resultados de testosterona (T) por cromatografía líquida en tandem con espectrometría de masa (LC-MS/MS) y por kits comerciales convalidados o no por LC-MS/MS

Objective: To compare normal and hirsute women Testosterone (T) measurements performed at different laboratories by the same or different methods, and the gold standard method LC-MS/MS (Quest Diagnostics, USA). Design: Prospective study. Setting: Hormone Determination Laboratory, Hospital Italiano, La Plata, and each participating laboratory's private practice. Patient(s): Blood samples were obtained from 23 individuals sorted into two groups, namely, normal women, n: 11(NW) and hirsute women, n: 12 (HW). Interventions(s): None. Main Outcome Measure(s): To evaluate whether serum T measurements obtained from each serum by the methods currently employed in our country, some of whose kits exhibit changes in previous presentations, some LC-MS/MS-validated and other non-validated ones are significantly different from those obtained by LC-MS/MS. Result(s): None of the 11 NW showed high T values by LC-MS/MS. Two out of the 12 hirsute patients showed normal T values (LC-MS/MS). Methods and number of participating labs -shown between brackets were: in NW, 1st generation Architect (1), 2nd generation Architect (1); Immulite (1) Cobas (4); Access (1); Centaur (2); Immunotech-RIA (1); and, in HW, 2nd generation Architect (3); Immulite (3); Cobas (4); Access (1); Centaur (2); Immunotech-RIA (1). No false positives resulted from the assays performed. No lab yielded false positive results in the NW group. No false positives were reported from the 10 hirsute women with increased T values by LC-MS/MS. False positives, though, resulted from two female hirsute patients with normal T values studied by four of the methods. Statistically, the serum T measurements obtained were significantly different by Centaur in NW and, in HW, by Immulite and Centaur as compared to LC-MS/MS. In the Bland-Altman plot, Centaur and Cobas showed over 5 % of measurements outside the limits of agreement in the HW group. Assessment by p-Spearman resulted in divergences with LC-MS/MS for all methods in NW, whereas in the HW group there were none. When estimating sampling bias for each laboratory taking LC-MS/MS as the reference method and adopting a ± 6.4 % mean bias acceptability criterion for each method compared to LC-MS/MS, two of the techniques reviewed, 2nd generation Architect and Cobas, met the validation requirement satisfactorily. However, one lab out of three using 2nd generation Architect failed to meet the validation requirement, while two out of four labs using Cobas also failed to meet the requirement. This demonstrates the great variability among methods, even when labs are employing the same technique. Conclusion: From the clinical point of view, the methods currently used in our local environment yielded no false positives or false negatives and therefore did not misdiagnose hyperandrogenism. Still, Immulite, Centaur, RIA and Access did present false positives in two of the T-normal hirsute women. The relation of serum T measurements obtained by each method to measurements obtained by LC-MS/MS reveals that the dispersion of the results was larger with values under 0.3 ng/ml, quite close to the detection limit of the various techniques.

Objetivos: Comparar los resultados de testosterona (T) obtenidos en diferentes laboratorios en mujeres normales (MN) e hirsutas (MH), empleando el mismo o diferentes métodos respecto a la técnica de cromatografía líquida en tándem con espectrometría de masa LC-MS/MS (gold standard) realizada en el laboratorio Quest (USA) Protocolo: Estudio prospectivo Estudio realizado en: Laboratorio de Determinaciones Hormonales; Hospital Italiano de La Plata y en los laboratorios privados de cada participante Pacientes: Se obtuvieron muestras de sangre periférica en 23 mujeres agrupadas en 2 grupos: controles normales (n:11) y en mujeres hirsutas (n: 12) Intervención: Ninguna. Principales resultados a evaluar: Evaluar si con los métodos habituales empleados en nuestro medio con los diferentes kits comerciales, de los cuales algunos han sido convalidados por técnica "gold standard" y otros no, presentan diferencias significativas con los obtenidos por LC-MS/MS Resultados: Los resultados obtenidos por LC-MS/MS mostraron que ninguna de las 11 MN tuvieron niveles aumentado de T y 2 MH tuvieron valores normales de T. Los métodos empleados y el número de laboratorios (entre paréntesis) que emplearon cada método fueron en MN Architect 1st generation (1) Architect 2nd generation (1); Immulite (1); Cobas (4); Access (1); Centauro (2); Immunotech-RIA (1). En las MH Architect 2nd generation (3); Immulite (3); Cobas (4); Access (1); Centauro (2); Immunotech-RIA (1). En el grupo de MN en ningún laboratorio (lab) se obtuvieron resultados falsos positivos. En el grupo de MH no se obtuvieron falsos negativos en las 10 hirsutas con valores aumentados de T por LC-MS/MS. En las 2 pacientes hirsutas con T normal en 4 métodos se obtuvieron falsos positivos Estadísticamente los resultados fueron significativamente diferentes, en las MN por Centauro y en las MH por Immulite y Centauro. En el análisis de Bland-Altman Centauro y Cobas en las MH presentaron más del 5 % de los resultados fuera del límite de acuerdo. Resultados por p-Speerman todos los métodos fueron diferentes a LC-MSMS en las MN y no se obtuvieron diferencias en el grupo de MH. Evaluando el bias de cada muestra en cada laboratorio respecto a LC-MS/MS y adoptando el criterio de aceptabilidad de ± 6,4 % mean bias de cada método respecto al de LC-MS/MS, 2 de las metodologías estudiadas, Architect 2da generación y Cobas pasaron satisfactoriamente el requisito de validación, sin embargo de los 3 laboratorios que emplearon 2da generación, 1 no pasó el criterio de validación y de los 4 que usaron Cobas, 2 tampoco lo pasaron. Esto demuestra la gran variabilidad de los métodos aun entre lab que emplean la misma técnica. Conclusiones: Desde el punto de vista clínico los métodos habitualmente empleados en nuestro medio, no sobrediagnosticaron o subdiagnosticaron hiperandrogenismo, por no presentar falsos positivos o negativos respectivamente. Sin embargo Immulite, Centauro, RIA y Access presentaron falsos positivos en las 2 hirsutas con T normal. En la relación de los resultados de cada muestra en cada método sobre el valor de LC-MS/MS referido a la concentración de T en ese suero por LC-MS/MS, la mayor dispersión de los resultados se observaron con valores menores de 0,3 ng/ml, muy cercano al límite de detección de las diferentes técnicas.

[Factors associated with self-directed learning among medical students]. / Predictores afectivos y académicos del aprendizaje autodirigido en estudiantes de medicina.

BACKGROUND: Self-directed learning is a skill that must be taught and evaluated in future physicians. AIM: To analyze the association between self-directed learning, self-esteem, self-efficacy, time management and academic commitment among medical students. MATERIAL AND METHODS: The self-directed learning, Rosemberg self-esteem, general self- efficacy, time management and Utrecht work engagement scales were applied to 297 first year medical students. RESULTS: A multiple regression analysis showed a significant association between self-efficacy, time management and academic commitment with self-directed learning. Self-esteem and satisfaction with studies did not enter in the model. CONCLUSIONS: self-esteem, academic commitment and a good time management were associated with self-directed learning in these students.

Prevalence and characteristics of women reporting poor mental health during pregnancy: Findings from the 2010 French National Perinatal Survey.

BACKGROUND: Self-rated mental health is a useful indicator to examine the positive dimension of mental health and psychological well-being. The primary objective of this study was to estimate the prevalence of poor self-rated mental health during pregnancy in a nationally representative population in France. The second objective was to assess the sociodemographic and medical characteristics associated with this condition and with a health professional's consultation for psychological problems. METHODS: The study was based on the 2010 French National Perinatal Survey, which included all singleton live births in French maternity units during a 1-week period (n=14,326 women). Self-rated mental health was assessed using the following single-item question: "During your pregnancy, how did you feel from a psychological point of view: good - fairly good - rather poor - poor?" Women were also asked if they had visited a healthcare professional for psychological problems. They were interviewed between delivery and discharge to collect information on mental health, sociodemographic and medical characteristics, the context of their pregnancy, and their prenatal care. RESULTS: Of the women interviewed, 8.9% [95% CI, 8.5-9.5%] reported poor self-rated mental health during pregnancy. Among them, 18.7% consulted a healthcare professional for psychological problems. Sociodemographic characteristics indicative of social disadvantage were associated with a higher-risk of poor self-rated mental health, and a social gradient was observed. However, more favorable social characteristics were associated with consultation with a healthcare professional for these psychological difficulties. The reaction to the discovery of pregnancy and prenatal care differed significantly depending on self-rated mental health. Women with poor mental health had more complicated pregnancies. CONCLUSION: This study showed strong associations between many socially disadvantaged characteristics and a positive dimension of mental health. The findings suggest that well-being measures such as self-rated mental health should be routinely assessed during pregnancy so that women can be offered more appropriate support.

Predictores afectivos y académicos del aprendizaje autodirigido en estudiantes de medicina / Factors associated with self-directed learning among medical students

Background: Self-directed learning is a skill that must be taught and evaluated in future physicians. Aim: To analyze the association between self-directed learning, self-esteem, self-efficacy, time management and academic commitment among medical students. Material and methods: The self-directed learning, Rosemberg self-esteem, general self- efficacy, time management and Utrecht work engagement scales were applied to 297 first year medical students. Results: A multiple regression analysis showed a significant association between self-efficacy, time management and academic commitment with self-directed learning. Self-esteem and satisfaction with studies did not enter in the model. Conclusions: self-esteem, academic commitment and a good time management were associated with self-directed learning in these students.

[Learning strategies of autonomous medical students]. / ¿Cómo abordan su aprendizaje los estudiantes de medicina autónomos? Una aproximación cualitativa.

BACKGROUND: Understanding how autonomous students are capable of regulating their own learning process is essential to develop self-directed teaching methods. AIM: To understand how self-directed medical students approach learning in medical schools at University of Concepción, Chile. MATERIAL AND METHODS: A qualitative and descriptive study, performed according to Grounded Theory guidelines, following Strauss & Corbin was performed. Twenty medical students were selected by the maximum variation sampling method. The data collection technique was carried out by a semi-structured thematic interview. Students were interviewed by researchers after an informed consent procedure. Data were analyzed by the open coding method using Atlas-ti 7.5.2 software. RESULTS: Self-directed learners were characterized by being good planners and managing their time correctly. Students performed a diligent selection of contents to study based on reliable literature sources, theoretical relevance and type of evaluation. They also emphasized the discussion of clinical cases, where theoretical contents can be applied. This modality allows them to gain a global view of theoretical contents, to verbalize knowledge and to obtain a learning feedback. CONCLUSIONS: The learning process of autonomous students is intentional and planned.