Information and Communication Technology, Mobile Devices, and Medical Education.

Information and communication technologies (ICT) are practical and highly available tools. In medical education, ICTs allow physicians to update their knowledge and remember the necessary information within reach of current mobile devices. ICTs as preparation tools for medical education have not been reported for medical students in Mexico. To assess the use of mobile devices as ICTs with medical education purposes, we distributed a questionnaire through an online survey management system to all the medical students (n = 180) from a private university in Mexico City, 100% agreed to participate. We developed a questionnaire based on previous surveys and adapted it to our university. All participants reported possession of an electronic mobile device, and 95% used it regularly for learning purposes. Regardless of the school year, the most frequent usage given to these devices was the search and reading of medical articles, the use of medical calculators, and taking notes. As the levels in career advances, there was a reduction in the use of electronic devices. According to the students, the main barriers towards using mobile devices for learning purposes were both the lack of access to the Internet and permission from the professor to use them. Most medical students use mobile devices for learning purposes, but usage changes during their education. It is convenient to encourage the use of mobile devices and the development of ICT skills as tools for educational purposes rather than banning their use in schools and hospitals.

Expectant management of severe preeclampsia remote from term: the MEXPRE Latin Study, a randomized, multicenter clinical trial.

OBJECTIVE: The objective of the study was to determine whether expectant management of severe preeclampsia prior to 34 weeks of gestation results in improved neonatal outcome in countries with limited resources. STUDY DESIGN: This was a randomized clinical trial performed in 8 tertiary hospitals in Latin America. Criteria of randomization included gestational age between 28 and 33 weeks' gestation and the presence of severe hypertensive disorders. Patients were randomized to steroids with prompt delivery (PD group) after 48 hours vs steroids and expectant management (EXM group). The primary outcome was perinatal mortality. RESULTS: A total of 267 patients were randomized, 133 to the PD group and 134 to the EXM group. Pregnancy prolongation was 2.2 days for the PD group vs 10.3 days for the EXM group (P = .0001). The rate of perinatal mortality (9.4% vs 8.7%; P = .81; relative risk [RR], 0.91; 95% confidence interval [CI], 0.34-1.93) was not improved with expectant management, and neither was the composite of neonatal morbidities (56.4% vs 55.6%; P = .89; RR, 01.01; 95% CI, 0.81-1.26). There was no significant difference in maternal morbidity in the EXM group compared with the PD group (25.2% vs 20.3%; P = .34; RR, 1.24; 95% CI, 0.79-1.94). However, small gestational age (21.7% vs 9.4%; P = .005; RR, 2.27; 95% CI, 1.21-4.14) and abruption were more common with expectant management (RR, 5.07; 95% CI, 1.13-22.7; P = .01). There were no maternal deaths. CONCLUSION: This study does not demonstrate neonatal benefit with expectant management of severe preeclampsia from 28 to 34 weeks. Additionally, a conservative approach may increase the risk of abruption and small for gestational age.

[Age of onset symptoms and gender in schizophrenic spectrum disorders]. / Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico.

INTRODUCTION: Some controversy exists concerning whether the onset of schizophrenia and some clinical characteristics of the disorder are different between males and females. OBJECTIVE: The relationship between sex, age at onset and negative symptoms was evaluated in patients with schizophrenic spectrum disorders. MATERIALS AND METHODS: A sample of 225 patients (89 women and 136 men) were diagnosed for schizophrenia between 2008 and 2009. Each was compared for age at onset of symptoms and SANS score (Scale for the Assessment of Negative Symptoms). Kernel density estimators were used to evaluate characteristics of age of onset with respect to gender. Parameters of the mixed distributions were estimated via maximum-likelihood algorithms. Relationships between negative symptoms score and age of onset were evaluated using multiple regression analysis. RESULTS: A significant difference was found in age at onset across gender (mean age of 24.5 years in men, 27.5 years in women). An association was found between gender and early onset of symptoms, with early onset occurring more frequently in male patients. Density estimates for age at onset suggested a mixture model with three components having as parameters: m1=21.55 +/- SD 5.25; m2=29.54 +/- SD 7.22; m3=40.01 +/- 3.98. When density estimates took into account gender, two bimodal structures were found--(1) men with the lowest mean (18.0 years) and (2) the highest mean in middle-aged women (41.0 years). Regression coefficients suggested an increase in negative symptoms as time of disease increased. CONCLUSION: The hypothesis was supported that a relationship exists between age of onset of symptoms, gender and clinical characteristics in patients with schizophrenic spectrum disorders, showing that men have an early onset an a more deteriorating course than women.

Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico / Age of onset symptoms and gender in schizophrenic spectrum disorders

Introducción. Existe controversia sobre la posibilidad de que la edad de inicio de la esquizofrenia y de algunas características clínicas del trastorno, sean diferentes entre hombres y mujeres. Objetivo. Evaluar la relación entre sexo, edad de inicio y síntomas negativos en pacientes con trastornos del espectro esquizofrénico. Materiales y métodos. Se evaluaron 225 pacientes para medir la edad de inicio de los síntomas y el puntaje en la escala SANS (Scale for the Assessment of Negative Symptoms). Se usaron estimadores de densidad kernel para evaluar las características de la edad de inicio. Se estimaron los parámetros de distribuciones mezcladas usando algoritmos de máxima verosimilitud. La relación síntomas negativos-edad de inicio se evaluó usando regresión múltiple. Resultados. Hubo diferencia significativa en la edad de inicio según el sexo (24,5 años en hombres Vs. 27,5 años en mujeres). Se encontró asociación entre sexo y comienzo temprano de síntomas, siendo este último más frecuente en hombres. Los estimadores de densidad para la edad de inicio sugieren un modelo mezclado con tres componentes, con los siguientes parámetros: m1=21,55, sd1=5,25; m2=29,54, sd2=7,22; y m3=40,01, sd3=3,98. Al tener en cuenta el sexo, se aíslan dos estructuras bimodales: la de hombres tiene la menor media de edad de inicio (18,02 años) mientras que la de media más alta corresponde a las mujeres (41,03 años). Los coeficientes de regresión sugieren incremento en los síntomas negativos a medida que aumenta el tiempo con enfermedad. Conclusión. Nuestros resultados apoyan la hipótesis de que existe relación entre la edad de inicio de los síntomas, el sexo y las características clínicas, en pacientes con trastornos del espectro esquizofrénico, lo que demuestra que los hombres tienen un inicio más temprano y un curso de la enfermedad con mayor deterioro.

Introduction. Some controversy exists concerning whether the onset of schizophrenia and some clinical characteristics of the disorder are different between males and females. Objective. The relationship between sex, age at onset and negative symptoms was evaluated in patients with schizophrenic spectrum disorders. Materials and methods. A sample of 225 patients (89 women and 136 men) were diagnosed for schizophrenia between 2008 and 2009. Each was compared for age at onset of symptoms and SANS score (Scale for the Assessment of Negative Symptoms). Kernel density estimators were used to evaluate characteristics of age of onset with respect to gender. Parameters of the mixed distributions were estimated via maximum-likelihood algorithms. Relationships between negative symptoms score and age of onset were evaluated using multiple regression analysis. Results. A significant difference was found in age at onset across gender (mean age of 24.5 years in men, 27.5 years in women). An association was found between gender and early onset of symptoms, with early onset occurring more frequently in male patients. Density estimates for age at onset suggested a mixture model with three components having as parameters: m1=21.55 +/- SD 5.25; m2=29.54 +/- SD 7.22; m3=40.01 +/- 3.98. When density estimates took into account gender, two bimodal structures were found--(1) men with the lowest mean (18.0 years) and (2) the highest mean in middle-aged women (41.0 years). Regression coefficients suggested an increase in negative symptoms as time of disease increased. Conclusion. The hypothesis was supported that a relationship exists between age of onset of symptoms, gender and clinical characteristics in patients with schizophrenic spectrum disorders, showing that men have an early onset an a more deteriorating course than women.

Síntomas obsesivo-compulsivos en pacientes con patologías del espectro esquizofrénico: frecuencia y relación con características clínicas / Obsessive compulsive symptoms in patients with pathological schizophrenia: frequency and relation with clinical characteristics

Introducción: Los estudios sobre comorbilidad entre trastorno obsesivo-compulsivo (TOC) o síntomas TOC y esquizofrenia arrojan mucha variabilidad en los reportes de frecuencia. La presencia de estos síntomas en la esquizofrenia se ha asociado, principalmente, a la gravedadde la enfermedad. El objetivo del presente estudio es estimar la frecuencia de síntomas obsesivos en pacientes con diagnóstico de esquizofrenia o trastorno esquizofreniforme y evaluar su relación con las características clínicas del cuadro. Resultados: Un total de 222 pacientes con diagnóstico DSM-IV de esquizofrenia o trastorno esquizoafectivo fueron evaluados mediante las escalas SANS, SAPS, BPRS, EMUN, Zung y la lista de comprobación de obsesiones y compulsiones de Yale-Brown. No se encontraron casos con TOC. Hubo una frecuencia de síntomas TOC del 4,5% (IC 95% 2,2%-8,1%). Los síntomas TOC se asociaron a deterioro cognoscitivo y social. Conclusiones: En diferentes estadios de la enfermedad la presencia de esta comorbilidad podría ser marcador de protección o de deterioro cognoscitivo y social. El TOC y los síntomas TOC representan diferentes dimensiones en el paciente esquizofrénico...

Introduction: Comorbidity studies of frequency of OCD or OCD symptoms and schizophrenia show very high variability. The presence of these symptoms in schizophrenia has been related to factors like severity of disease. The objective of this study is to estimate the frequency of obsessive-compulsive symptoms in patients having schizophrenia or schizoaffective disorder and to evaluate its relationship with clinical characteristics. Results: A total of 222 patients have been evaluated using SANS, SAPS, BPRS, EMUN and Zung scales and the Y-BOCS Symptom Checklist. No cases of OCD have been found. The frequency of OCD symptoms was 4.5% (95% CI 2.2% 8.1%). OCD symptoms were associated with social and cognitive impairment. Conclusions: OCD and OCD symptoms represent distinct dimensions in schizophrenic patients. Its presence in different stages of the disease could indicate impairment or protection against more disruptive signs of psychosis...

Informe final: Curso por encuentro sobre diagnóstico, tratamiento y prevención de intoxicaciones agudas causadas por plaguicidas

Documento que describe todas las actividades realizadas por los participantes en el Curso, los niveles de asimilación, logros y dificultades encontrados en la capacitación. De la misma mnera, aporta una serie de elementos para mejorar los cursos a dsitancia y superar las dificultades encontradas en éste.