Effectiveness of an integrative health-care model for climacteric-stage women.

OBJECTIVES: To evaluate an integrative health-care model (IHCM) with an empowerment approach for self-care in terms of improving health-related quality of life (HR-QoL) and lifestyle. METHODS: We conducted a field trial with one intervention (IHCM) and one comparison group receiving usual care (UC), with ex ante and ex post measurements. The IHCM was provided for 3 months to each woman in the first group, with follow-up of both groups at 3 and 6 months. The differences in differences estimator was used to assess the effect of intervention, adjusting for clinically important covariates in the framework of a generalized linear regression model. RESULTS: A total of 380 women (IHCM 190 and UC 190) participated in the study. The differences in differences estimator between IHCM and UC for aerobic physical activity was 81 and 87 min/week at 3 and 6 months, respectively; for consumption of dairy products, fruit and vegetables the estimator was 4.8, 6.6 and 9.4 servings per week respectively at 3 months, and 3.9, 6.3 and 9.7 servings at 6 months. The effect of IHCM on HR-QoL at 3 months was greater for the domains of vasomotor, somatic symptoms and sleep problems (11.7, 10.0 and 13.2 points, respectively); at 6 months the differences of major positive change were observed in the domains of memory/concentration, vasomotor symptoms and sleep problems (12.2, 10.4 and 10.8 points, respectively). CONCLUSION: The results support the importance of patient-centered health care during the climacteric stage, within integrative care programs with an empowerment approach.

[Persistence of critical-reading learning in medical residents]. / Persistencia del aprendizaje de lectura crítica en médicos residentes.

OBJECTIVES: 1. To evaluate the persistence of a training course on critical reading of medical articles by medical residents seven months after training. 2. To compare the persistence of training according to type of training (participative vs expositive). METHODS: We used the same groups of first year medical residents of a previous study. They had received seven months before a 30 hours training in the reading of research articles: Group I (N = 28) had a course of active participation by reading articles previous to meeting discussions; II (n = 17) exposition of research themes by active researchers; III (n = 23) same as II but with non-research trainers. Using an examination questionnaire developed and validated by us to explore critical reading of research papers, the trainees were scored after finishing their training (initial score). Seven months later we retested them using the same test (not all were retested: two were missing in groups I and III and six in Group II). Non parametric statistics were used to compare the groups (Wilcoxon, Kruskal-Wallis, Mann-Whitney). RESULTS: There were no intragroup differences of the retesting versus the initial median in the three groups (I had 17.5 vs 19 initial, II had 7 vs 13, III had 6 vs 3). In the initial testing, Groups I and II scored higher than III, but only Group I was higher than the other groups upon retesting (p < 0.006). CONCLUSION: An active participatory training to promote critical reading was better than the traditional training techniques still widely used.

[Respect for the interests of pediatric patients]. / El respeto a los intereses de los pacientes pediátricos.

Physicians face situations involving ethical values. In the absence of instruments for exploring ethical issues in pediatric practice we developed a questionnaire (PEIPP: acronym in Spanish of implicit ethical principles in pediatric practice) to identify whether pediatricians show respect to the attributions of patients. PEIPP was validated by iterative evaluation by experts: a Kuder Richardson's coefficient of 0.98 and a concordance mean index of 0.80 were obtained. PEIPP included two kinds of vignettes: three vignettes exploring how physicians provide information to patients, and seven of how pediatricians make decisions in some specific circumstances. Five groups of pediatric residents (n = 53) and three groups of pediatricians (n = 76) in three hospitals participated. Globally there were no differences between residents and staff. In the vignettes exploring actions, there was a large variability in the answers whereas in the vignettes of information there was a general tendency to select the options indicating a respectful attitude. There was no correlation in the respectfulness between the two types of vignettes, nor between respectfulness and years of experience of the pediatricians. Less than 10% of residents and pediatricians showed a high consistency in answers indicating respectfulness. We conclude that a respectful attitude is not common in the group of physicians studied.

[Effect of an educational strategy on critical reading among medical students]. / Efecto de una estrategia educativa sobre la lectura crítica de estudiantes de medicina.

We developed an educational intervention aimed at promoting the participation of the undergraduate medical students in the classroom in order to improve critical reading, specifically in the skills of comprehension and interpretation. The study is a quasi-experimental one with basal evaluation, educational intervention, and posintervention evaluation. We included two groups of top medical students with a high school individual grade of 9 or higher (in a scale 0 to 10) designated as A groups (experimental [N = 29] and control [N = 23]), and two groups of students with low grades (7 or less) designated as B groups (experimental [n = 20] and control [n = 16]). The experimental educational intervention consisted of the use of guided housework for text interpretation (individual work) and groupal work in the classroom. The groupal work included a debate and confrontation of viewpoints of the individual work. Comprehension was initially superior to interpretation in all groups; comprehension and interpretation were lower in the B groups compared with the A groups. After the intervention, 97% of the students from the A experimental group showed an improvement in comprehension and 79% improved their interpretation (p < 0.001). Of the students in the B experimental group, 75% showed improvement in comprehension and 90% in interpretation (p < 0.01). There were no significant changes in the students of the control groups. We find that with the use of an appropriate educational intervention, students with low scores have the opportunity to improve their critical reading by gaining skills in comprehension and interpretation.

[Clinical competence in systemic arterial hypertension of undergraduate students at 2 schools of medicine]. / Competencia clínica en hipertensión arterial sistémica de alumnos de pregrado de dos escuelas de medicina.

OBJECTIVES: A) To develop and validate a questionnaire for exploring clinical competence of medical students in Hypertensive Vascular Disease. B) To know and compare clinical competence among medical students of two medical schools, who are about to be caring for hypertensive patients. DESIGN: Cross-sectional study. METHODS: The questionnaire was developed with actual clinical cases and 150 items for exploring clinical abilities; experts, medical attendants in the Mexican Social Security Institute validated it. The questionnaire had to be answered by students from two medical universities about to graduate. RESULTS: We obtained a Kuder Richardson coefficient of 0.89. There were significant differences between students when we compared total scores, especially in three of the nine indicators explored. In the group 1, 94% of its students has clinical competence qualifying as low and very low, and; 87% of group 2 has clinical competence qualifying as intermediate or low. When we explored the items corresponding to treatment there is no significant difference and almost all the students are in clinical competence low and very low or as if they hadn't studied medicine. CONCLUSIONS: We consider that the questionnaire was valid and reliable. The clinical competence of the students included from universities that were included in this study, is deficient in resolving the clinical cases presented in the questionnaire. Therefore, it is probably that they will not give adequate clinical care to patients with hypertension, so it is important to improve the clinical competence of the future general practitioners, at least during their year of social service.

[Capacity for critical reading of clinical research among groups of medical residents]. / Capacidad de lectura crítica de investigación clínica en grupos de residentes médicos.

OBJECTIVE: To explore the association of length of clinical training and ability to read critically clinical research papers in groups of residents of internal medicine. MATERIAL AND METHODS: An instrument to evaluate critical reading was developed validated by four experts in clinical epidemiology. It contains four abstract from international medical journals. Each article was followed by 20 questions of false/true/ do not know options: 42 were interpretation items and 38 were judgement items. Each article had a semantic differential scale from 1 to 10 of global value of the paper. Seventy internal medicine residents participated: 20 in their first year of residency, 31 in the second year and 19 in the third year. RESULTS: There were no differences between overall scores according to year of training (global median score of 22.5 out of 80 as a maximum). Globally the interpretation items reached a median of 22 versus 9 in the in the judgement items (p < 0.01). A tendency to underestimate the validity of the articles by the residents was observed, i.e. their overall validity was significantly lower than that of the experts (p < 0.001). Finally, there was a correlation of 0.45 between the scores in this study and those obtained during their medical studies. CONCLUSION: These groups of residents were not influenced by length of their training during their internal medicine residency and their ability to judge clinical investigation papers.

[Comparison of 2 educational strategies in critical reading of resident physicians]. / Comparación de dos estrategias educativas en la lectura crítica de médicos residentes.

OBJECTIVE: To compare an educational strategy for promoting the participation versus the traditional teaching of research in medical residents. MATERIAL AND METHODS: We generated a questionnaire validated by experts: to evaluate the critical reading of clinical epidemiology reports. It contains 75 items which explore interpretation judgements or proposals of modification to the reports. A total of 68 first year residents were included in three groups who were exposed for 27-28 hours in periodic sessions to training: group I was exposed to a critical reading strategy with active discussion promoted by a professor. Groups II and III had a traditional training with lectures using the same information in all groups. RESULTS: There were no group differences in their critical reading previous to receiving the training. Groups I and II increased their global medians basically in the interpretation skills. When the results were adjusted eliminate the chance-expected changes, only group I improved its critical reading. CONCLUSION: The strategy promoting student participation appeared to be superior to the traditional strategy in the training of our medical residents.