[Pedagogic implementation in medical education.]

The purpose of this study was to provide elements to consider the use and relevance of pedagogic instruments and strategies in medical education with a constructivist approach.Any teaching process should be supported by a plan, having a theoretical approach such as the curriculum, as well as teaching-learning strategies, pedagogic resources and evaluation instruments relevant to each learning process. In order to select a teaching-learning strategy, a professor should consider the following: learning objectives and goals, students' learning styles and available didactic resources. Evaluation should be appropriate to teaching principles and practices. Professors should keep in mind the availability of valid and reliable evaluation instruments that assess students' gained knowledge through authentic, real-life situations. Finally, because competences are a set of multidimensional and interrelated attributes (knowledge, clinical skills, techniques, attitudes), their appropriate evaluation is a challenge that will require several types of instruments.

[Critical reading of reports of educational research in teachers of IMSS. Multicenter study]. / Lectura crítica de informes de investigación educativa en profesores del IMSS. Estudio multicéntrico.

AIM: To determine the effect of an educational strategy promoting participation in the development of critical reading of educational research reports on professors of Educational Research and Teacher Education (CIEFD's). MATERIAL AND METHODS: We performed an intervention study, multicenter professors (medical specialists) who enrolled in the courses: Diploma in teaching methodological level 1 and 2 (n = 46, n = 29, respectively) in the six CIEFD's (D.F. Siglo XXI, DF. La Raza, Nuevo León, Sonora, Puebla and Jalisco), in the period March to August 2007. A tool was built that assessed the variables critical appraisal of educational research reports, the construct validity, content and reliability was assessed by experts in education research. The educational strategy developed in the form of seminars, which were held three times a week in the Certification in teaching methodological level 1 and twice per week in the Certification Level 2 in teaching methodology duration per session: 6 h. The instrument was applied at the beginning and end of the course. RESULTS: In the two Graduates it was observed in the total group, an advance in the three indicators of critical reading, which was expressed with statistically significant differences; in the global score of the Diploma level 1 (final vs. initial measurement) the following mediums were observed: 36-67 (p = 0.0001); in the Diploma level 2, it was observed in its overall rating: 42-78 (p = 0.0001). DISCUSSION: This inquiry from the results observed some of theoretical approaches to mainstreaming participatory. CONCLUSION: An educational strategy promoting participation produced a breakthrough in the three indicators (to interpret, to judge and to formulate proposals) for critical reading of educational research reports.

[Participatory education and the development of critical reading in teachers theoretical texts. Multicenter study]. / Educación participativa y el desarrollo de la lectura crítica de textos teóricos en profesores. Estudio multicéntrico.

AIM: Determine what the relationship between participation in classroom of students attending courses at the Educational Research and Teacher Education (CIEFD's) and the development of proficiency in critical reading of theoretical texts in education. MATERIAL AND METHODS: Intervention study, multicenter students (medical specialist) level Diploma in teaching methodology (DMDN) 1 and 2 (n=46 n=29) of the six CIEFD's (DF Siglo XXI, Mexico City La Raza, Nuevo Leon, Sonora, Puebla and Veracruz), period: March to August 2007 and a Masters in education (n=9, generation 2007-2008). Two instruments were constructed that evaluated the participation variables and critical reading of theoretical texts in education, conceptual validity; content and reliability were assessed by experts in education research. The educational intervention was in the form of seminars (three times a week in DMDN 1 and twice weekly in DMDN 2 and Masters). Participation was assessed halfway through the course and on completion, critical reading at the beginning as well as the end. RESULTS: Statistically significant associations were observed in DMDN 1 (four Centers) and the Masters, but not DMDN 2. DISCUSSION: In this investigation some of the theoretical proposals of the participatory education were recreated, starting from the analysis of our results. CONCLUSION: In some centers and in the masters, strengthening participation in this educational intervention is related to the development of critical reading of theoretical texts in education.

[Developing critical skills to analyze research reports in nuclear medicine]. / Alcances de una estrategia educativa desde una perspectiva participativa de la educación en el desarrollo de lectura crítica de informes de investigación en médicos residentes de medicina nuclear.

OBJECTIVE: To estimate the impact of an educational strategy aimed at developing critical reading of research reports among medical residents enrolled in a nuclear medicine course. METHODS: We carried out an intervention study to measure the degree to which students developed critical reading skills in a one month period (May-June, 2007). We developed an instrument that included five summaries of research articles in nuclear medicine and 96 sentences that measured four indicators (interpret, judge, propose, and assessment of technical and technological aspects). The instrument's internal validity was measured using the Kuder-Richardson test (KR 20 = 0.89) stratified in five scores: very low (17-32), low (33-48), medium (49-64), high (65-80) and very high (81-96). Non-paramentric statistics was employed to determine significant differences. RESULTS: At the beginning of the intervention, 0.80 of participating residents scored in the "very low" domain of critical reading even after controlling for a random effect. At the end of the study, 0.90 scored in the "medium" category. Results were statistically significant (p = 0.02). CONCLUSIONS: The educational strategy tested, fostered the development of critical reading skills among a sample of nuclear medicine residents.

Alcances de una estrategia educativa desde una perspectiva participativa de la educación en el desarrollo de lectura crítica de informes de investigación en médicos residentes de medicina nuclear / Developing critical skills to analyze research reports in nuclear medicine

Objetivo: Estimar los alcances de una estrategia educativa en el desarrollo de la lectura crítica de informes de investigación en médicos residentes de medicina nuclear. Métodos: Estudio de intervención entre mayo y junio de 2007 para medir el grado de desarrollo de lectura crítica en médicos residentes de medicina nuclear. Se elaboró un instrumento con cinco resúmenes de informes de investigación en medicina nuclear, con 96 enunciados que exploraron cuatro indicadores (interpretar, enjuiciar, proponer y valoración de aspectos técnicos y tecnológicos). Se estimó la confiabilidad interna con la prueba de Kuder-Richardson 20 (0.89). Se conformaron cinco categorías: muy bajo (17-32), bajo (33-48), medio (49-64), alto (65-80) y muy alto (81-96). El análisis estadístico se realizó con estadística no paramétrica. Resultados: Al inicio de la estrategia, 80 % de los residentes mostró un grado de dominio de lectura crítica muy bajo e incluso calificaciones dentro de lo explicable por efecto del azar; al final de la misma, 90% alcanzó un dominio medio. Las diferencias fueron estadísticamente significativas (p=0.02). Conclusiones: La estrategia educativa propició un avance en el desarrollo de lectura crítica de informes de investigación en medicina nuclear.

OBJECTIVE: To estimate the impact of an educational strategy aimed at developing critical reading of research reports among medical residents enrolled in a nuclear medicine course. METHODS: We carried out an intervention study to measure the degree to which students developed critical reading skills in a one month period (May-June, 2007). We developed an instrument that included five summaries of research articles in nuclear medicine and 96 sentences that measured four indicators (interpret, judge, propose, and assessment of technical and technological aspects). The instrument's internal validity was measured using the Kuder-Richardson test (KR 20 = 0.89) stratified in five scores: very low (17-32), low (33-48), medium (49-64), high (65-80) and very high (81-96). Non-paramentric statistics was employed to determine significant differences. RESULTS: At the beginning of the intervention, 0.80 of participating residents scored in the [quot ]very low[quot ] domain of critical reading even after controlling for a random effect. At the end of the study, 0.90 scored in the [quot ]medium[quot ] category. Results were statistically significant (p = 0.02). CONCLUSIONS: The educational strategy tested, fostered the development of critical reading skills among a sample of nuclear medicine residents.

[Clinical competence of anesthesiology residents in patients requiring hospital care in the specialty hospital "Siglo XXI"]. / Competencia clínica de los residentes de anestesiología en pacientes que requieren atención médica en un hospital de especialidades.

INTRODUCTION: The study of clinical competence is essential because it summarizes the attributes that characterize a specialist capable of providing quality health care OBJECTIVE: Investigate the development of clinical competence among anesthesiology residents that care for patients in a tertiary level facility. MATERIAL AND METHODS: In February 2007 we conducted a cross-sectional study among 42 anesthesiology residents, 21 were in second and 21 in third year. In order to measure the degree of development of clinical competence we created an instrument with four case studies that summarized patients undergoing surgical anesthetic procedure. The instrument included 200 items that explored eight indicators and covered a range of time periods: pre-trans and post anesthesia. The instrument was validated by a group of experts with clinical, teaching and publication experience. We carried out a pilot test and estimated the instrument's internal reliability using the Kuder-Richardson test (KR-21). We obtained a coefficient of 0.95. We collected the study data and instrument rating technique using a blinded design. Statistical analysis was performed using nonparametric tests. RESULTS: In the overall ranking, third-year medical residents versus sophomores, achieved the highest scores, which resulted in statistically significant differences (p = 0.045). Regarding the degree of expertise we found that most participants had scores of "very low" and "low". In the study of ratings by indicator, we noted that when comparing second vs third year residents we only found statistically significant differences in default decisions that were also potentially iatropathogenic (p = 0.026). CONCLUSION: The clinical competence of anesthesiology residents who care for patients attending a tertiary level facility is low when compared with the maximum theoretical scores they should obtain.

[Critical reading of clinical investigation among oncology residents]. / Lectura crítica de artículos de investigación clínica en médicos residentes de oncología.

OBJECTIVE: To estimate the development degree to critical reading aptitude of clinical investigation papers among oncology residents. METHODS: A transversal study with 40 oncology residents (surgical oncology, 17; medical oncology, 15; and radio-oncology, 8) was done. An instrument containing six abstracts of clinical articles selected according to a clinical purpose, methodological design and approach to the three most frequent malignancies in Mexico with 150 items to explore three critical reading aptitude indicators was constructed; experts validated it. A pilot test was done in 20 internal medicine residents; a Kuder-Richardson coefficient of 0.90 was obtained to estimate the internal reliability. The instrument was applied simultaneously. RESULTS: The overall scores were low without difference among specialties (37.5, 35.5 and 38.0, respectively; maximum score: 150). According to indicators, the best score was observed to interpret and to treat, while the score to propose decreased in accordance with the higher specialty degree. CONCLUSIONS: The aptitude development degree to critical reading among oncology residents was deficient. A better environment to develop a more critical and reflexive education should be considerated.

[Critical reading of clinical investigation reports in pregraduate students]. / Lectura crítica de informes de investigación clínica en estudiantes de pregrado.

OBJECTIVE: To evaluate the development of critical reading (CR) of clinical research texts (CRT) in medical students. METHODS: In 65 students an instrument for the evaluation of CR of CRT was applied. Four groups from three universities were studied: an academic excellence group (n = 21), B1 (n = 19) and B2 (n = 12), C (n = 13). The instrument had eight CRT with 150 items; 50 items to any of the following indicators: interpretation, judgment and proposition. The items were balanced in 50 % false and 50 % true. It was analyzed the global management degrade and by indicator. STATISTICAL ANALYSIS: Kruskal-Wallis and Mann-Whitney U test was used. RESULTS: Age 22 (median) 20-28 (range) years, gender 56.9 % women, without differences between the three universities. The global score was 50.5 (8 to 112). Group A had statistically significant higher results in global score and by indicator (p < 0.001) in relation with the other universities. According to the interpretation, judgment and proposition indicators, group A had the higher score. CONCLUSIONS: The results are similar to those observed in medical residents, because the development degrade for CR reading was low.

[Achievements of an educational strategy promoting participation in the development of clinical aptitude and critical reading in cardiology residents, linked to appropriate use of research reports]. / Alcances de una estrategia educativa promotora de la participación en el desarrollo de la aptitud clínica y lectura crítica en residentes de cardiología, vinculando el uso apropiado de los informes de investigación.

OBJECTIVE: To search the reach of educative strategy promoting the participation, to estimate the development of clinical aptitude and critical reading attaching the appropriate use of clinic research in cardiology residents. MATERIAL AND METHODS: Prospective study. The instrument of clinical aptitude was constructed with five cases and 170 items and the instrument of critical reading was developed with five summaries of articles of clinical research in cardiology by 120 items. The strategy was performed with activities one a week during six months by two hours per class, in the period: March and September, 2005. Reading guides were delivered to the participants a week before that included a clinical case and clinic research of cardiology. During the activities in class we were promoting the participation and discussion. Both measuring instruments were performed in the first (initial measuring) and final session (final measuring). Non parametric test were used because the variable of the subjects were not normal distribution and the scale was ordinal. RESULTS: The reliability coefficient in both instruments with the Kuder-Richardson was 0.90 and 0.85 respectively. After educative strategy was observed a significant advance in the global calcifications, such as in critical reading and in clinical aptitude (p = 0.001 and 0.5 respectively). Analyzing in an independent manner the components of critical reading we found significant advancement in the indicators interpretation and judgment. In clinical aptitude we found significant progress in the indicators: the suitable use of paraclinics resources, the appropriate use of therapeutics measurement and iatropatogenic decisions for omission. CONCLUSIONS: The educative strategy promoting the participation, permitted to get a change in the clinical aptitude and critical reading attaching the appropriate use of sources of investigation in cardiology residents.

[Educative intervention and development of position and critical reading]. / Postura ante la educación y desarrollo de la aptitud en lectura crítica en profesores de cursos técnicos. Una intervención educativa.

OBJECTIVE: To investigate the professors of technical courses of the area of health, the effects of a promotional educative strategy of the participation in the development of a position prior to the education and of the aptitude for the critical theoretical text reading and information of educative research. MATERIAL AND METHODS: A longitudinal study took place, of intervention. In order to measure the degree of development of a position before the education, it was applied to the instrument Concepts and ideas about education. It consists of 72 statements, organized in duple that expresses two different approaches from education: participative and passive. For the inquiry of the degree of development of critical reading two instruments were applied: 1) Theoretical text reading of education and, 2) Reading information of educative research, constituted both by 120 itemes. The validity and trustworthiness of the three instruments were valued by experts with experience in teaching and educative research. The strategy was implemented through activities in seminary form, which were done twice a week, with a duration of five hours per session, for nine months; within the activities outside the classroom, the student completed reading of a theoretical text and/or report of educative research and the resolution of a reading guide (task). During the activities in a propitious classroom, discussion atmosphere and promoting at any moment the participation of the students; a space for the reflective recovery of their own experience was opened, for the analysis and interchange of ideas and for the critic and self-criticism of the main educative practices. The professor intervened when individual participation diminished; he also channeled the discussion, indicating to the enlightening observations and strong arguments of the students. The three instruments were applied to the group of professors of technical courses (n = 10); the initial measurement was applied before initiating the educative strategy and the final measurement at the end of the same plan. The qualification of the instruments and the capture of information were made by a blind technical worker. RESULTS: Subsequent to the educative strategy we observed a statistically significant advance in position -inferred through its main indicator: critical theoretical text consequence- and reading. The advances shown in critical reading for information of educative research were below the critical theoretical text reading. CONCLUSIONS: The development of position before the education and the aptitudes for critical reading of theoretical texts and information of educative research, in professors of technical courses of the area of health, it is possible, if educative atmospheres are created that lead to the participation -halfway through by the critic.

Desarrollo de la aptitud clínica de médicos internos de pregrado en anemias carenciales mediante una estrategia educativa promotora de la participación / Developing undergraduate medical boarding's clinical aptitude in anemic deficiencies with a participation promotive educational strategy

Objective. To compare the profit of a participation promotive educational strategy versus traditional teaching on development of the undergraduate medical boarding's clinical aptitude. Methods. A quasiexperimental design was made. An instrument was built and validated in order to explore clinical aptitude. It contains three actual clinical cases about iron, folie acid or cobalamin deficiency, and a questionnaire with 164 items to explore eight clinical aptitude indicators; experts attending and teaching physicians validated it. A Kuder-Richardson coefficient of 0.80 was gotten when we estimated the internal reliability. The instrument was applied simultaneously to 55 undergraduate medical boarding from two hospitals of the Instituto Mexicano del Seguro Social the starting year of undergraduate boarding (initial measuring) and at finish once again (end measuring). The experimental group (GE, n = 29) was exposed to a participation promotive educational strategy, and control group (GC, n = 26) to a traditional one. Results. The overall scores of initial measuring in the GE and GC were low: 57 y 42 respectively (maximum: 164); at end measuring an increase in overall scores was observed: in the GE 68 (p < 0.02) and GC 47 (NS). Conclusions. The participation pro-motive educational strategy is better than traditional teaching for developing the undergraduate medical boarding's clinical aptitude. It must be considerated to propitiate changes to develop a more reflexive and critical education.

Objetivo. Estimar los alcances de una estrategia educativa promotora de la participación vs. una tradicional (habitual) sobre el desarrollo de la aptitud clínica en médicos internos de pregrado. Material y métodos. Se efectuó un diseño cuasiexperimental. Se construyó un instrumento de medición con tres casos clínicos reales sobre anemias carenciales y 164 ítemes que exploran ocho indicadores de aptitud clínica; validado por ronda de expertos con experiencia docente y en trabajos de investigación publicados; la confiabilidad interna se estimó con la fórmula 21 de Kuder-Richardson, obteniendo un coeficiente de 0.80. El instrumento se aplicó a dos grupos de médicos internos de pregrado correspondientes a dos hospitales del IMSS; la medición inicial se aplicó antes de iniciar el internado de pregrado y la medición final al término del mismo. El grupo experimental (GE, n = 29) fue intervenido con la estrategia educativa promotora de la participación y el grupo de control (GC, n = 26) con la estrategia tradicional. Resultados. Las calificaciones globales (medianas) obtenidas en la medición inicial en el GE y GC, fueron bajas (57 y 42, respectivamente, de una calificación teórica máxima de 164); en la medición final se observó un incremento de la calificación en el GE a 68 (p < 0.02) y en el GC a 47 (NS). Conclusiones. La estrategia educativa promotora de la participación mostró algunos efectos superiores respecto a la tradicional en el desarrollo de la aptitud clínica en médicos internos de pregrado. Esto se debe tomar en cuenta para propiciar cambios hacia el desarrollo de una educación más reflexiva y crítica.

[Developing undergraduate medical boarding's clinical aptitude in anemic deficiencies with a participation promotive educational strategy]. / Desarrollo de la aptitud clínica de medicos internos de pregrado en anemias carenciales mediante una estrategia educativa promotora de la participación.

OBJECTIVE: To compare the profit of a participation promotive educational strategy versus traditional teaching on development of the undergraduate medical boarding's clinical aptitude. METHODS: A quasiexperimental design was made. An instrument was built and validated in order to explore clinical aptitude. It contains three actual clinical cases about iron, folic acid or cobalamin deficiency, and a questionnaire with 164 items to explore eight clinical aptitude indicators; experts attending and teaching physicians validated it. A Kuder-Richardson coefficient of 0.80 was gotten when we estimated the internal reliability. The instrument was applied simultaneously to 55 undergraduate medical boarding from two hospitals of the Instituto Mexicano del Seguro Social the starting year of undergraduate boarding (initial measuring) and at finish once again (end measuring). The experimental group (GE, n = 29) was exposed to a participation promotive educational strategy, and control group (GC, n = 26) to a traditional one. RESULTS: The overall scores of initial measuring in the GE and GC were low: 57 y 42 respectively (maximum: 164); at end measuring an increase in overall scores was observed: in the GE 68 (p < 0.02) and GC 47 (NS). CONCLUSIONS: The participation promotive educational strategy is better than traditional teaching for developing the undergraduate medical boarding's clinical aptitude. It must be considerated to propitiate changes to develop a more reflexive and critical education.

Lectura crítica en estudiantes de enfermería: Efectos de una estrategia educativa / Critical reading in nursing students: effects of an educational strategy

Introducción: La educación refleja y reproduce las diversas condiciones históricas, sociales y culturales de la sociedad que la crea. Objetivo: Valorar la utilidad de una estrategia educativa promotora de la participación en estudiantes de licenciatura en enfermería y obstetricia sobre el desarrollo de la lectura crítica. Material y métodos: se realizó un estudio cuasiexperimental. La población estuvo constituida por dos grupos naturales de séptimo semestre de la licenciatura en enfermería, el experimental (GE) conformado por 22 alumnos, a los que se aplicó una estrategia educativa que buscó promover la participación de los alumnos y el grupo control (GC) integrado por 17 alumnos en el cual se llevó una estrategia educativa habitual. La primera se basó en tareas individuales (extraclase) y trabajo en aula en grupos de discusión y debate así como sesiones plenarias. La segunda se llevó en la forma tradicional de trabajo por parte del profesor y del alumno. Para estimar el grado de avance en la lectura crítica se utilizó un instrumento previamente elaborado y validado. Resultados: La medición basal de ambos grupos mostró diferencias estadísticamente significativas a favor del GC en los indicadores estudiados; comprensión GC=21, GE=-4, interpretación GC=8 y GE=-14; para ambos casos p <0.0001. Posterior a las intervenciones el GE mostró cambios significativos, en contraste del GC. Al comparar ambos grupos después de las intervenciones no se observaron diferencias estadísticamente significativas en las capacidades estudiadas (se igualaron los grupos). Discusión: Fue fundamental el papel del profesor para desplegar los recursos necesarios para avanzar y desarrollar la riqueza potencial de los alumnos sometidos a la estrategia educativa.

Purpose: To validate the of an educative participation promoting strategy in baccalaurente nursing and obstetrics students, about the development of theoretic education texts' critical reading in the nursing education subject. Materials and methods: A quasiexperimental study was performed. The population consisted of two "natural" seventh semester groups of baccalaureate nursing students. The experimental group (GE) consisted of 22 students in which an educative strategy was applied that pretended to promote students' participation ; the control group (GC) consisted of 17 students where a habitual strategy was applied. The former was based on individual homeworks (out of class) and class work in discussion and debate groups as well as plenary sessions. The latter was in the traditional way to work by tacher and students. A previously elaborated and validated instrument was used to calculate the advance degree in critical reading. Results: Significant differences, statistically significant were found in the basal score of both groups in favour of the control group in the studied indexes: comprehension: GC= 21, GE =-4; interpretation GC= 8 and GE= -14; p<0.0001 in both cases. GC showed no differences after the interventon; however, GE did show significant charges. Comparing both groups after the interventions statistically significant were not found in the studied capacities (both groups egualed).

Ambiente educativo en medicina: propuesta de un instrumento de evaluación / Proposal of an evaluation instrument for the educative environment in the medical field

Objetivo: construir y validar un instrumento que explore las características del ambiente educativo donde se lleva a cabo la formación de médicos, para investigar si son promotoras de la participación del alumno en la elaboración de su conocimiento. Material y métodos: con base en dos enfoques de la educación, uno pasivo-receptivo y otro activo-participativo, se construyó un instrumento para explorar diversos indicadores relacionados con las condiciones que prevalecen en el ambiente donde se forman los futuros médicos. Fue sometido a procesos de validación de contenido y se obtuvieron estimaciones de confiabilidad. El coeficiente de confiabilidad fue de 0.81 mediante prueba de Kuder-Richardson y de 60, mediante la prueba de Kappa ponderada. Conclusiones: el instrumento posee características que le dan confiabilidad y consistencia, y puede ser utilizado para explorar cómo son los ambientes donde se lleva a cabo el proceso de formación de médicos en pre y posgrado.

Aptitud para la lectura crítica de informes de investigaciones clínicas en médicos residentes del IMSS en Jalisco / Aptitude for critical reafing of clinical research reports in medical residents of the IMSS in Jalisco

Objetivo. Indagar el grado de aptitud para la lectura crítica de informes de investigación clínica en los residentes de las diferentes áreas de especialidad médica. Material y métodos. Se elaboró y validó un instrumento para explorar la lectura crítica en sus habilidades de interpretar y enjuiciar. Se estudió a 572 médicos residentes de ocho unidades del Instituto Mexicano del Seguro Social: 292 del área médica, 227 del área quirúrgica, 30 del área de auxiliares de diagnóstico y 23 del área de investigación. Resultados. Las calificaciones globales (medianas) obtenidas fueron bajas (considerando una calificación teórica máxima de 100) para los residentes de tres áreas: médica con 34, quirúrgica con 30 y auxiliares de diagnóstico con 28.5. Para el área de investigación, la aptitud fue de grado medio con 49. De los 572 residentes 98 (17.1 por ciento) no rebasó el límite de las calificaciones explicables por efecto del azar. En el área médica se encontró un efecto diferencial positivo de los años de residencia en la aptitud para la lectura crítica, particularmente en la especialidad de medicina interna. Conclusiones. El desarrollo de la aptitud para la lectura crítica de informes de investigación clínica en general es bajo, la excepción son los residentes en investigación y en cierta medida los de medicina interna; en esta última parece producto de un ejercicio intencional, grupal, sistemático y progresivo.

Lectura crítica en médicos residentes de las especialidades troncales / Critical reading in medical residents

Objetivo. Explorar el grado de desarrollo de la habilidad para la lectura crítica de informes de investigación clínica en los alumnos de las cuatro especialidades troncales: medicina interna, pediatría, cirugía general y ginecología/obstetricia. Material y métodos. Se realizó un estudio en médicos residentes de 12 hospitales del Instituto Mexicano del Seguro Social: 143 alumnos de medicina interna, 119 de pediatría, 74 de cirugía general y 74 de ginecología/obstetricia. Se construyó y validó un instrumento para explorar la lectura crítica en sus tres capacidades: interpretación, juicios y propuestas. Resultados. En ninguna de las especialidades consideradas se encontró efecto significativo de los años de formación sobre la capacidad para leer críticamente informes de investigación clínica. Así también los puntajes (medianas) obtenidos en la calificación global fueron bajos (considerando una calificación máxima teórica de 120); medicina interna: 35, pediatría: 29, cirugía general: 24.5 y ginecología/obstetricia: 25. Un 28 por ciento (116 alumnos de una población de 410) no superó el nivel de calificación explicable por efecto del azar. Conclusiones. En este estudio, la comparación entre los años de experiencia en la residencia para cada especialidad no mostró diferencias, lo cual sugiere que han resultado poco fructíferos en el desarrollo de la habilidad de lectura crítica de informes de investigación clínica, y el grado de desarrollo observado de la misma es bajo

Bacteriuria asintomática recurrente en el embarazo y bajo peso al nacimiento / Asymptomatic recurrent bacteriuria during pregnancy and low birth weight

Las infecciones del tracto urinario representan las complicaciones más frecuentes en el embarazo; de tal forma se señala una prevalecencia promedio de 4 a 7 por ciento de bacteriuria asintomática durante esta etapa. El propósito de esta investigación es estudiar la asociación entre la bacteriuria asintomática recurrente (BAR) durante el embarazo y el bajo peso del recién nacido. Se efectuo un estudio de cohortes en derechohabientes adscritas a la unidad de Medicina Familiar No.10 en Jalapa, Veracruz, en el periodo de enero a diciembre de 1996. Para determinar esta asociación en una población de 846 embarazadas se estudio una muestra de 118 casos, formándose dos grupos: 59 con BAR (grupo experimental) y 59 sin BAR (grupo control). Las gestantes fueron estudiadas cuando acudieron a control prenatal realizándoles un urocultivo cuantitativo, el cual de resultar positivo requirió corroboración con otro. La prevalencia de BAR observada fue de 6.97 por ciento. Las diferencias encontradas al estudiar la asociación entre bacteriuria asintomática recurrente durante el embarazo y bajo peso del recién nacido no fueron estadísticamente significativas

Diabetes mellitus tipo II y disfunción sexual eréctil: estudio de 50 casos / Diabetes mellitus type II and sexual erectile dysfunction: study of 50 cases

La diabetes mellitus y la hipertensión arterial se han convertido en algunos de los problemas cronicodegenerativos más frecuentes. El propósito de este estudio fue determinar la frecuencia de asociación entre la diabetes mellitus tipo II y la disfunción sexual eréctil en un primer nivel de atención médica. Se realizó una investigación prospectiva, transversal, comparativa y observacional en derechohabientes diabéticos, de 30 a 45 años de edad, adscritos a la Unidad de Medicina Familiar Núm. 57 del Instituto Mexicano del Seguro Social, Veracruz, Ver., durante un periodo de seis meses (1994). Para determinar la frecuencia de esta disfunción, se aplicó un cuestionario a la pareja y se realizaron exploraciones clínicas neurológicas. Se empleó una muestra aleatoria de 100 pacientes divididos en dos grupos: 50 diabéticos y 50 no diabéticos. El mayor número de casos de disfunción sexual eréctil se encontró en el grupo de 40 a 45 años. Los datos fueron tratados con el estadístico chi cuadrada, nivel de significación 0.05. En conclusión, las diferencias al estudiar la frecuencia de asociación entre estas dos variables fueron estadísticamente significativas.

Conocimiento de las medidas para prevenir el VIH por parte de los adolescentes / Adolescent's awareness of measures for preventing VIH

El SIDA (síndrome de inmunodeficiencia adquirida) se ha convertido rápidamente en un problema de salud pública mundial. El propósito de este estudio fue evaluar el nivel de conocimiento de los adolescentes repecto a las medidas preventivas relacionadas con el VIH, virus de inmunodefiencia humana. Se realizó una investigación prospectiva, transversal, descriptiva y observacional en escuelas secundarias, preparatorias y en la UMF 57, Unidad de Medicina Familiar No. 57, de la ciudad de Veracruz, México. Para evaluar el nivel cognoscitivo alto, principalmente en los grupos de 15 a 16 y 17 a 18 años de las escuelas particulares, pero también se observó que todavía existen conceptos erróneos. El hecho de que la infección continúe en forma ascendente, a pesar del nivel cognoscitivo observado, hace pensar en la multitud de factores que intervienen y en la ineficacia de las estrategias de intervención desarrolladas hasta el momento, que no han logrado la suficiente concientización ni el cambio sostenido de conductas para prevenir este problemas

Depresión en jubilados no activos: estudio de 234 casos / Depresion of the non active retired: report of 234 cases

La depresión es uno de los trastornos más comunes en el primer nivel de atención médica. El propósito de este estudio fue investigar la relación entre jubilación y síndrome depresivo. Se realizó investigación analítica, prospectiva, transversal, comparativa y observacional en la unidad de Medicina Familiar No. 10, Jalapa, Ver., del Instituto mexicano del Seguro Social. Para valorar la presencia de depresión, se aplicó la escala de Hamilton en un periodo de treinta meses (1991-1993), empleando una muestra aleatoria de 468 pacientes: 234 jubilados no activos y 234 no jubilados, en los que se observó depresión en 169 casos (36.11 por ciento) y 96 casos (20.51 por ciento), respectivamente. Los casos de jubilación y depresión estuvieron relacionados con las variables: edad, sexo, escolaridad, estado civil, actitud de rechazo del jubilado respecto a la jubilación y actividades no satisfactorias realizadas durante dicho proceso. Los datos fueron tratados con la variabel estadística chi cuadrada y el nivel de significación fue de 0.05. Las cifras encontradas al estudiar la relación entre jubilación y depresión fueron estadísticamente significativas