[Study of the introduction of the European Credit Transfer System (ECTS) in pediatrics and modification of the teaching methodology]. / Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente.

INTRODUCTION: Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. OBJECTIVES: To test the introduction of the ECTS in pediatrics and modify the teaching methodology. STUDY DESIGN: The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. RESULTS: Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. CONCLUSIONS: Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated.

Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente / Study of the introduction of the european credit transfer system (ECTS) in pediatrics and modification of the teaching methodology

Introducción Las Facultades Médicas españolas han comenzado el nuevo proceso de reforma curricular en el marco del proceso de implantación del Espacio Europeo de Educación Superior y deben incorporar el Sistema de Transferencia de Créditos Europeo (ECTS) a los nuevos planes del estudio antes de 2010. Objetivos El objetivo del trabajo fue experimentar la introducción de los créditos ECTS en la asignatura de Pediatría y modificar la metodología docente. Diseño del estudio Adaptación del programa teórico y práctico, estableciendo unos objetivos docentes y un sistema de evaluación. Se realizaron encuestas a los alumnos al inicio del segundo cuatrimestre del curso 2004-2005, antes de realizar el examen teórico de la asignatura y al finalizar el curso académico, utilizando para las respuestas una escala de tipo Likert con 5 grados. Se comparó la priorización de las competencias genéricas y específicas de los alumnos con la de los profesionales médicos en la encuesta de la Conferencia Nacional de Decanos (CND). Para el análisis de los resultados se aplicaron pruebas no paramétricas. Resultados Los 15 créditos actuales se transformaron en 11 ECTS, con 297 h de trabajo para los alumnos. Se redujo el programa teórico de 80 a 52 lecciones. Los alumnos prepararon y presentaron 14 casos clínicos, bajo la supervisión de sus tutores. Los profesores consideraron que el aprendizaje teórico había sido similar al de cursos anteriores (66,6 %) y había sido mejor el práctico (73,3 %). Los alumnos opinaron que el proyecto debía continuar (73,2 %), pero el 98,8 % consideraron que la carga de trabajo había sido excesiva. Los alumnos apreciaron de forma estadísticamente significativa que mejoró la docencia práctica y su capacidad para preparar y presentar casos clínicos. El rendimiento académico de los alumnos fue significativamente mejor que el de los alumnos del curso anterior. Los estudiantes estuvieron de acuerdo con la prioridad de competencias de la CND para 9/9 de las generales y 4/17 de las específicas. La estimación de horas de trabajo de los alumnos fue mayor por los alumnos que por los profesores. El 73,3 % de los alumnos contestaron que el proyecto debía mejorarse, reduciendo la carga de trabajo de los alumnos y mejorando el sistema de evaluación. Conclusiones La introducción de los ECTS mejoró el rendimiento académico, la formación práctica y el autoaprendizaje de los alumnos. La experiencia fue satisfactoria para profesores y alumnos. La estimación de la carga de trabajo de los alumnos fue subestimada

Introduction Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. Objectives To test the introduction of the ECTS in pediatrics and modify the teaching methodology. Study design The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. Results Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. Conclusions Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated

[Utility of congenital hypothyroidism screening in neonates for monitoring iodine deficit disorders in the Canary Islands (Spain)]. / Utilidad del programa de cribado neonatal del hipotiroidismo congénito para la valoración de la deficiencia de yodo en Canarias.

BACKGROUND: Newborns in European cities where iodine intake is low have been demonstrated to present high frequencies of transitory hypothyroidism. Because the neonatal period is critical for cerebral development, this is a cause for concern. Published studies (WHO/UNICEF/ICCIDD) indicate that neonates with a thyroid-stimulating hormone (TSH) concentration of more than 5 mU/ml revealed by screening for congenital hypothyroidism present mild iodine deficiency. OBJECTIVE: To analyze the utility of TSH values as an indicator of the prevalence of iodine deficiency in the general population. MATERIAL AND METHODS: We prospectively evaluated 19 809 neonates, corresponding to all the neonates screened from May 2001 to April 2002 in the Canary Islands.TSH determination in whole blood dried on filter paper was performed using immunofluorescence (Delphia) in the Center for the Detection of Metabolic Disorders in the Canary Islands. The percentage of neonates in each island with TSH values of > 5 mU/l was calculated. Samples of cord blood were not used. RESULTS: A total of 19 809 infants were analyzed. Of these 1800 had values of TSH > 5 mU/L, representing 9.08 % of neonates. The mean age at blood extraction was 4.31 6 3.78 days (range: 0.5-40). The percentage of neonates with values of THS > 5 mU/L in each island was 13.1 % in Gran Canaria, 5.1 % in Lanzarote, 7.3 % in Fuerteventura, 6.0 % in Tenerife, 6.2 % in La Palma, 6.6 % in Gomera and 10.1 % in Hierro. In 77.5 % of neonates in Gran Canaria blood was extracted for screening within the first 72 hours of life and 15.2 % of these neonates had TSH concentrations of > 5 mU/L. In 22.5 % of neonates blood was extracted on the third day of life or later and 7.9 % of these neonates had TSH values of > 5 mU/L. CONCLUSIONS: In the Canary Islands, the percentage of neonates with iodine deficiency, according to elevated TSH levels detected screening for congenital hyperthyroidism, was small. The validity of TSH level as an indicator of the prevalence of iodine deficiency in the general population is influenced by the days of life at which the blood sample is taken.

Utilidad del programa de cribado neonatal del hipotiroidismo congénito para la valoración de la deficiencia de yodo en Canarias / Utility of congenital hypothyroidism screening in neonates for monitoring iodine deficit disorders in the canary islands (spain)

Antecedentes: Se ha demostrado que los recién nacidos en ciudades europeas con baja ingesta de yodo presentan una mayor tasa de hipotiroidismo transitorio, lo cual es preocupante dado que ocurre en un período crítico del desarrollo cerebral. Se ha señalado (OMS/UNICEF/ICCIDD) que cuando la concentración de hormona tirostimulante (TSH) en la prueba de cribado neonatal del hipotiroidismo congénito es mayor de 5 mU/l existiría un déficit de yodo. Objetivo: Analizar la utilidad del valor de la TSH como indicador de la prevalencia del déficit de yodo en la población de nuestra comunidad. Material y métodos: Se han estudiado prospectivamente 19.809 recién nacidos, que corresponden a todos los recién nacidos cribados en la comunidad de Canarias entre el 1 de mayo de 2001 al 31 de abril de 2002.La determinación de TSH en sangre entera seca sobre papel de filtro se llevó a cabo en el Centro de Detección de Metabolopatías de la Comunidad de Canarias por el método de inmunofluorescencia (Delphia). Se recogió el porcentaje de recién nacidos que en cada isla tenía un valor de TSH neonatal mayor de 5 mU/l. No se utilizaron muestras extraídas de sangre de cordón. Resultados: El número de niños analizados durante el período de estudio fue de 19.809 y de ellos 1.800 tenían valores de TSH > 5 mU/l, lo que supone el 9,08 por ciento de los recién nacidos, con una edad media en el momento de la toma de 4,31 3,78 días (límites, 0,5- 140). Por islas, el porcentaje de recién nacidos con valores de THS > 5 mU/l fue: Gran Canaria, 13,1 por ciento; Lanzarote, 5,1 por ciento; Fuerteventura, 7,3 por ciento; Tenerife, 6,0 por ciento; La Palma, 6,2 por ciento; Gomera, 6,6 por ciento y Hierro, 10,1 por ciento. En Gran Canaria la muestra de sangre para el cribado fue obtenida en el 77,5 por ciento de los recién nacidos con menos de 72 h de vida y en estos niños el porcentaje de casos con TSH > 5 mU/l fue del 15,2 por ciento, mientras que en el 22,5 por ciento de los recién nacidos la muestra fue tomada con 3 días o más de vida y en ellos el porcentaje de casos con valores de TSH > 5 mU/l fue del 7,9 por ciento. Conclusiones: El déficit de yodo en Canarias fue ligero, según el porcentaje de casos con TSH elevada encontrado en el programa de cribado neonatal del hipotiroidismo congénito. La validez del valor de la TSH neonatal como indicador de la prevalencia del déficit de yodo está mediado por los días de vida en los que se realiza la toma (AU)

Hair zinc and copper in chronic alcoholics.

Chronic alcoholics frequently show associated malnutrition. Both ethanol and malnutrition exert profound changes on zinc and copper metabolism. In this study, we found higher hair zinc and copper values in 43 male alcoholics than in 39 controls. Hair copper was significantly related to the amount of ethanol consumed, whereas hair zinc was higher in consumers of distilled beverages. No relation was observed between hair zinc and copper and nutritional status, kind of diet consumed, style of life, and liver cirrhosis. Consequently, hair zinc and copper levels are related only with alcohol intake.

[Smoking in adolescents, saliva cotinine concentrations and respiratory disease]. / Tabaquismo en adolescentes, valores de cotinina en saliva y enfermedad respiratoria.

OBJECTIVE: To assess cotinine levels in the saliva of adolescents and the relationship between these levels, smoking habits and respiratory disease. PATIENTS AND METHODS: We studied 420 adolescents (54.7% boys and 45.3% girls) aged between 14 and 21 years (mean age, 16.4 +/- 1.32), from state and private schools in Tenerife. An individualized survey, based on the American Thoracic Society's model, was carried out and saliva cotinine concentrations were determined by radioimmunoassay. RESULTS: Distribution according to smoking habits was as follows: 26.5% were regular smokers, 11% were sporadic smokers, 3.6% were former smokers, 45.6% were passive smokers, and 13.4% were not exposed to smoking. Mean cotinine levels were 225.4 ng/ml in regular smokers, 19.5 ng/ml in sporadic smokers, 17.4 ng/ml in former smokers, 4.2 ng/ml in passive smokers and 2.2 ng/ml in individuals not exposed to tobacco smoke, which demonstrated the correlation between saliva cotinine concentrations and smoking habits (p=0.0001). The cotinine level in smokers of <10 cigarettes/day was 142,7 ng/ml and in smokers of >10 cigarettes/day it was 341,1 ng/ml (p=0.0001). A significant correlation was also found between cotinine concentrations and the number of cigarettes smoked regularly and in the last 24 hours before sample collection (p=0.0001). Lower respiratory tract infection (p=0.0001), chronic cough (p=0.0001) and bronchospasm on physical exercise (p=0.0001) were more frequent in adolescents with higher cotinine concentrations. CONCLUSIONS: Higher saliva cotinine concentrations were correlated with greater tobacco consumption and exposure to tobacco smoke. Adolescents with lower respiratory tract infections, chronic cough and bronchospasm on physical exercise had higher saliva cotinine concentrations.

Tabaquismo en adolescentes, valores de cotinina en saliva y enfermedad respiratoria / Smoking in adolescents, saliva cotinine concentrations and respiratory disease objective

OBJETIVO: Determinar la cotinina en saliva en adolescentes y su relación con el hábito de fumar y la enfermedad respiratoria. PACIENTES Y MÉTODOS: Se estudiaron 420 adolescentes, de ambos sexos, con edades entre 14 y 21 años (media, 16,4 ± 1,32) de colegios públicos y privados de Tenerife. El 54,7% eran varones y el 45,3%, mujeres. Se trata de una encuesta individualizada, según modelo de la American Thoracic Society y determinación de cotinina en saliva (RIA). Según el hábito tabáquico los adolescentes estaban distribuidos de la siguiente forma: 26,5%, fumadores habituales; 11%, fumadores esporádicos; 3,6 %, exfumadores; 45,6 %, fumadores pasivos, y 13,4%, no expuestos al humo del tabaco. RESULTADOS: La media de cotinina en saliva en los fumadores habituales fue 225,4 ± 167,4ng/ml; en los fumadores esporádicos, 19,5 ± 44,9ng/ml; en ex fumadores, 17,4 ± 51,1ng/ml; en fumadores pasivos, 4,2± 15,0ng/ml, y en los no expuestos, 2,2 ± 5,8ng/ml. Se encontró relación entre los valores de cotinina en saliva y el hábito tabáquico (p=0,0001).La media de cotinina en los fumadores de menos de 10 cigarrillos al día fue de 142,7 ± 131,5ng/ml y en los demás de 10 cigarrillos al día de 340,1 ± 144,9ng/ml, (p=0,0001). Asimismo, se encontró significación entre los valores de cotinina y el número de cigarrillos fumados habitualmente y en las últimas 24 horas antes de la obtención de la muestra (p=0,0001). Se observó mayor número de infecciones de vías bajas de repetición (p=0,0001), tos crónica (p=0,0001) y broncospasmo al ejercicio (p=0,0001), en los adolescentes con mayores valores de cotinina. CONCLUSIÓN: La cotinina en saliva se eleva con el mayor grado de consumo y de exposición al tabaco. Los adolescentes con infecciones de vías respiratoria bajas de repetición, tos crónica y broncospasmo al ejercicio, presentan concentraciones superiores de cotinina en saliva (AU)

Relative and combined effects of ethanol and protein deficiency on some hair trace elements: lack of relationship with body stores.

This study was performed in order to analyze the relative and combined effects of ethanol and protein deficiency on hair copper, zinc, manganese, and iron content in four groups of seven animals each which were pair-fed during 8 wk with (1) a nutritionally adequate diet, (2) a 36% (as energy) ethanol-containing isocaloric diet, (3) a 2% protein, isocaloric diet, and (4) a 36% ethanol, 2% protein isocaloric diet, respectively, following the Lieber-DeCarli model, and to analyze the relationship between hair copper, zinc, manganese, and iron content, and the liver and muscle content of these elements. Although there was a trend to higher levels of all the elements analyzed in the the hair of the low-protein fed animals, differences were statistically significant regarding copper and manganese, effects being solely attributable to the low protein diet, not to ethanol. Moreover, hair copper was significantly, inversely related with final weight and weight loss. There were significant relationship between liver zinc and muscle zinc (r = 0.57, p = 0.002), but not between liver or muscle zinc and hair zinc; no correlations were observed between muscle copper and hair copper, nor between liver manganese and hair manganese. An inverse, statistically significant correlation was observed between liver copper and hair copper (r = -0.39, p < 0.05).

[Exposure to tobacco and cotinine levels in children]. / Exposición al tabaco y niveles de cotinina en el niño.

OBJECTIVE: To evaluate the exposure of children and their parents to cigarette smoke by measuring cotinine levels in saliva. PATIENTS: A total of 151 children (84 males and 67 females) aged 15 days to 17 years from hospital and extrahospital practices. METHOD: Questionnaire on exposure to cigarette smoke from their parents, saliva cotinine levels by radioimmunoassay. RESULTS: Cotinine levels were higher in the passive smoker child than in the non-exposed child (p = 0.0001). A significant correlation was found between cotinine in the child and: a) total number of cigarettes smoked daily by both parents (p = 0.01); b) number of cigarettes smoked daily at home (p = 0.002), and c) number of cigarettes smoked at home in the 24 hours prior to sample obtention (p = 0.002). Higher levels of cotinine in the smoker parents than in the non-smoker parents were found (0.0001). CONCLUSIONS: The passive smoker child has high cotinine levels in saliva which are directly related to the exposure degree.

[Influence of growth hormone (GH) and nutrition on neonatal growth]. / Influencia de la GH y de la nutrición sobre el crecimiento en el periodo neonatal.

OBJECTIVE: At present, growth regulating factors in the transition from fetal to postnatal life remain unknown. The purpose of this study was to analyze the influence of GH and nutrition on neonatal growth. PATIENTS AND METHODS: Serum and 24-hour urine GH levels, various anthopometric variables and daily energy and nutrient intake were measured in appropriate (AGA), large (LGA) and small for gestational age (SGA) newborn infants. These variables were measured at 1 (n = 98), 3 (n = 41) and 5 weeks of postnatal age (n = 8). RESULTS: The highest GH levels at the 1st week of postnatal life were obtained in preterm SGA infants (GHs: 61.4 +/- 20.0 microUI/m; GHu: 18.6 +/- 10.3 ng/kg/24 h). GH levels decreased in preterm infants, so that differences between groups failed to be significant at the third and fifth weeks of postnatal life. Urinary GH excretion did not show significant variations in the control group during the study (1st wk 3.0 +/- 3.5; 3rd wk 2.3 +/- 2.7; 5th wk 3.2 +/- 4.7 ng/kg/24 h). Daily protein intake had a direct relationship with both triceps skinfold and weight and head perimeter increase. SGA preterm infants showed a higher fat increase compared to AGA preterm infants. Serum and urinary GH levels were not related to the anthopometric variables studied. CONCLUSIONS: There are differences in GH secretion and body composition between SGA and AGA preterm infants. GH probably does not contribute to neonatal growth.

[Trace elements and growth factors in the perinatal period]. / Elementos traza y factores de crecimiento en el período perinatal.

The objective of this study was to measure serum IGF-I, IGFBP-3, copper and zinc levels and to analyze their relationship to perinatal growth. Serum IGF-I (RIA after acid-ethanol extraction), IGFBP-3 (RIA), copper and zinc (atomic absorption spectrophotometry) levels were measured in cord blood (n = 78) and in newborn children 1 (n = 110) and 3 (n = 42) weeks after birth. Anthropometric variables were measured and the weekly average intake of energy and nutrients were calculated. We found that IGF-I and zinc levels during the 1st week of postnatal life were lower in fullterm LGA and AGA and in preterm (PT) AGA infants than in cord blood. The highest IGF-I levels were obtained in LGE fullterm infants (37.9 +/- 29.5 ng/mL) and the lowest in SGA preterm infants (9.3 +/- 10.3 ng/mL). Serum zinc levels in preterm neonates continued decreasing at the 3rd week after birth. However, IGF-I and IGFBP-3 levels increased significantly (IGF-I: 13.2 +/- 15.5 vs 34.5 +/- 27.3 ng/mL, p < 0.01; IGFBP-3: 364.3 +/- 185.1 vs 634.1 +/- 306.9 ng/mL, p < 0.01). Serum copper levels in the control group increased in relationship to the levels found at the 1st week of life, while this increase neither happened in fullterm SGA infants nor in preterm infants. A positive relationship was found between IGF-I and IGFBP-3. Both were directly connected to energy and protein intake. We conclude that intrauterine over-nutrition is related to higher IGF-I levels, whereas prematurity and intrauterine growth retardation are associated with lower zinc, IGF-I and IGFBP-3 levels and with a lack of increase in copper serum levels.

[Clinical evaluation of glycohemoglobin and serum glycoproteins using affinity chromatography in children with type I diabetes mellitus]. / Valoración clínica de la glicohemoglobina y glicoproteínas plasmáticas medidas por cromatografía de afinidad en niños con diabetes mellitus tipo I.

We measured in 67 diabetic and 40 non-diabetic children glycosylated haemoglobin levels by both affinity chromatography (Gly Hb) and cation exchange chromatography (Hb A1), glycosylated plasma proteins by affinity chromatography (Gly PP) and glycosylated serum proteins by the colorimetric method of thiobarbituric acid (PSG). There was in the diabetic children a significant linear correlation between these four determinations, as well as between them and the values in mean glycaemias and mean glycosurias. The average Hb A1 over a 20-month observation period was 11.7%; the mean Gly Hb, 12.7%; the mean Gly PP, 5.3%, and the average PSG, 0.77 nmol HMF/mg protein. Glycohaemoglobin levels were within the normal range in only 5% of the cases. About 25% of the diabetic children showed a bad therapeutic compliance, which progressively deteriorated when age and duration of disease increased. Daily insulin requirements and glycosylated haemoglobin levels were significantly higher in diabetic girls than boys, but these differences between sexes did not exist where concentration of glycosylated proteins was concerned. Values in glycohaemoglobin and glycoproteins increased together with age, duration of disease and insulin requirements, existing an inverse relationship with both duration of clinical remission period and socioeconomic level. Motivation, dietetic obedience and, above all, self-control compliance were the variables that exerted the greatest influence on glycohaemoglobin and glycoprotein levels.