Ana Sepulveda - Academia.edu (original) (raw)
Papers by Ana Sepulveda
Background. Depression and anxiety are common among medical residents. Coping strategies are cogn... more Background. Depression and anxiety are common among medical residents. Coping strategies are cognitive and conductual efforts in order to manage stress and specific individual demands. The use of active strategies has been associated with a lower frequency of anxiety and depression. Our objective was to determine if there is an association between depression and anxiety and the coping strategies used by medical residents.
![Research paper thumbnail of [Risk factors for the development of severe gastroesophageal reflux in neonates with congenital diaphragmatic hernia surgery]](https://attachments.academia-assets.com/91308017/thumbnails/1.jpg)
](Revista médica del Instituto Mexicano del Seguro Social, 2014
Gastroesophageal reflux after congenital diaphramatic hernia surgical correction occurs in up to ... more Gastroesophageal reflux after congenital diaphramatic hernia surgical correction occurs in up to 89 % of patients, out of which 20 to 30 % will require surgical management. Identification of risk factors for the development of this complication might allow for a Nissen fundoplication to be performed at the sime surgical time in those requiring it. The purpose of this research was to identify those factors in children with diaphragmatic hernia surgery. A case-control study was conducted, where patients with diaphragmatic hernia surgery treated between 2006 and 2011 were included. Patients with severe gastroesophageal reflux were regarded as the cases, whereas those who did not develop it over the 1-year follow up were the controls. Nine patients developed severe gastroesophageal reflux after the diaphragmatic hernia surgery. A large size of the hernia, it containing 4 or more organs, 10 days or more of ventilatory support requirement after the surgery or high mechanical ventilation v...
Archives of Medical Research, 2008
Background. Emesis and nausea are common adverse effects of chemotherapy. Consequences include de... more Background. Emesis and nausea are common adverse effects of chemotherapy. Consequences include dehydration, acute renal failure, esophageal rupture, electrolyte imbalance and undernutrition, among others. First-generation 5-HT3 antagonists significantly reduce these symptoms but are expensive and require administration every 8e12 h. Palonosetron, a second generation 5-HT3 antagonist has proven better results in adult populations. Other benefits include a one-dose administration with effect for up to 7 days and a lower treatment cost. No clinical studies have evaluated the safety and efficacy of palonosetron in children. Methods. Prior to every course, patients were randomized to receive palonosetron or ondansetron. Patients or guardians recorded the number of emetic events and the intensity of nausea over a 7-day period. They also reported any possible adverse effects. Statistical analysis included c 2 test, relative risk, and Student's t test. Results. Fifty courses were analyzed for each group. There was a significant reduction in emesis on the first 3 days and in the intensity of nausea in the first four days in the palonosetron group. There was an increased risk of presenting emesis and nausea in the acute phase when treated with ondansetron. No adverse effects were reported. The cost of treatment was also reduced when using palonosetron. Conclusions. Palonosetron is a safe and effective antiemetic treatment in children, as well as being cost effective.
Boletín médico del …, 2005
Dirección de Educación e Investigación en Salud, UMAE, Hospital de Pediatría, Centro Médico Nacio... more Dirección de Educación e Investigación en Salud, UMAE, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D. F., México. ... Solicitud de sobretiros: Dra.Ana Carolina Sepúlveda Vildósola, Unidad de Educación, ...
![Research paper thumbnail of [Music as an adjuvant treatment for anxiety in pediatric oncologic patients]](https://attachments.academia-assets.com/87961950/thumbnails/1.jpg)
](Revista médica del Instituto Mexicano del Seguro Social, 2014
Music has been used as adjuvant therapy for anxiety and it is based on scientific principles. Ton... more Music has been used as adjuvant therapy for anxiety and it is based on scientific principles. Tone, rhythm, harmony and time are crucial for its efficacy. Chemotherapy treatment frequently produces important stress in pediatric patients. This may delay treatment occasionally. Our objective was to determine if adjuvant therapy with music reduces anxiety in pediatric oncologic patients under ambulatory chemotherapy. Time series design. We included patients from 8 to 16 years of age who received ambulatory intravenous chemotherapy at the Hospital de Pediatría, Centro Médico Nacional Siglo XXI. They received treatment as usual on the first day, and music therapy during the second day of chemotherapy. A visual scale was used to categorize the level of anxiety prior and after treatment on both days. We included 22 patients. All patients experienced both moderate and high levels of anxiety prior to chemotherapy treatment on both days. There was a statistically significant reduction of anxi...
Archives of Medical Research, 2007
Revista De Psicopatologia Y Psicologia Clinica, Apr 1, 2013
Resumen: El estudio analiza la relación entre feminidad y conductas alimentarias inadecuadas en m... more Resumen: El estudio analiza la relación entre feminidad y conductas alimentarias inadecuadas en mujeres estudiantes de danza. El Eating Attitudes Test y el Conformity to the Feminine Norms Inventory fueron administrados a 50 estudiantes de grado medio y superior de danza y 75 estudiantes de bachiller y universitarios. Los resultados indican que el grupo de estudiantes de danza tenía un índice de masa corporal más bajo, estaba más satisfecho con su peso y presentaba con menor frecuencia conductas alimentarias inadecuadas relacionadas con los trastornos alimentarios (TA) que el grupo de estudiantes universitarios. Además, las estudiantes de danza con mayor riesgo de presentar conductas alimentarias inadecuadas se conformaban en mayor grado con la feminidad. La importancia de examinar las variables asociadas con el riesgo de TA, incluyendo la identificación con los roles de género, podría ser un paso adelante para mejorar la salud y la calidad de vida de las mujeres jóvenes.
Clinica Y Salud Num 1 Vol 15, 2015
... Variable Categoría Nº DE EFECTOS Medidas de imagen corporal Perceptivas cuerpo entero 42 efec... more ... Variable Categoría Nº DE EFECTOS Medidas de imagen corporal Perceptivas cuerpo entero 42 efectos (17.6%) Perceptivas cuerpo partes 53 efectos (22.3%) Actitudinal peso/forma 24 efectos (10.1%) Actitudinal global 119 efectos (50%) ...
Revista medica del Instituto Mexicano del Seguro Social
The prevalence of medical discontent is approximately 4%. Factors such as gender, age, type of sp... more The prevalence of medical discontent is approximately 4%. Factors such as gender, age, type of specialization, disillusion with the profession and economical factors have been identified among graduated medical doctors. Residents mentioned educational strategies as an additional factor of discomfort. To identify the prevalence and factors that influence on resident's discontent during their pediatric training program. The principal motives of dissatisfaction during the period of training in pediatric residence were identified using the semantic nets technique. Prevalence of dissatisfaction was 3.1%. The principal motives were: educational strategies, duration of medical career, work overload, hierarchical systems and abuse. Prevalence of dissatisfaction during a medical residence is similar to that reported in graduated pediatricians, and occurs during the first two years of residence. Educational strategies were one of the principal causes of discontent, and other local factors...
International Journal of Eating Disorders, 2015
Studies using traditional screening instruments tend to report a lower prevalence of eating disor... more Studies using traditional screening instruments tend to report a lower prevalence of eating disorders (EDs) in men than is observed in women. It is therefore unclear whether such instruments are valid for the assessment of ED in males. Lack of a formal diagnostic definition of muscle dysmorphia syndrome (MD) makes it difficult to identify men at risk. The study aimed to assess the prevalence of ED and MD in male university students of Buenos Aires. A cross-sectional, two-stage, representative survey was of 472 male students from six different schools in Buenos Aires, mostly aged between 18 and 28 years. The first stage involved administration of self-report questionnaires (Eating Attitude Test-26; scores ≥15 indicate "at risk" status). In Stage 2 students at risk of developing EDs were evaluated with a clinical interview, the Eating Disorder Examination (EDE; 12th edition). Two control students were interviewed for every at risk student. The prevalence of EDs among university male students was 1.9% (n = 9). All participants with an ED presented with illness classified as eating disorder not otherwise specified (EDNOS). Using the Drive for Muscularity Scale (DMS) with a 52-point threshold we identified possible MD in 6.99% (n = 33) of the sample. The prevalence of ED detected in this study is comparable with previous findings in male populations, and below that observed in female populations. However, the prevalence of possible cases of MD resembles the total rate of EDs in women. Characteristics associated with EDs and MD in men are also discussed. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015).
Revista medica del Instituto Mexicano del Seguro Social
To determine the risk factors associated with recurrent retinal detachment in patients vitrectomi... more To determine the risk factors associated with recurrent retinal detachment in patients vitrectomized. Case-control study nested in a cohort. We included patients with a diagnosis of rhegmatogenous retinal detachment treated with vitrectomy for one year, with a six months follow-up. We monitored the presence of incident event in the emergency department, and the examination room. Statistical analysis was performed by descriptive statistics (median, minimum and maximum) and inferential statistics (chi-squared test, Cox regression, Kaplan-Meier). A population of 94 patients with a median age of 55 years (21-83) was analyzed. The silicone was the most widely used type of tamponade in 62 patients (66 %) and recurrent retinal detachment occurred in 19 cases (20 %). In the relation between the non-relapse group and the relapse group, the statistically significant variable was the use of silicone (p = 0.05, OR = 0.03, 0.013-0.98), wich had a lower probability of recurrent detachment compare...
Revista médica del Instituto Mexicano del Seguro Social
The evaluation of clinical competence in medical residents is a complex procedure. Teachers need ... more The evaluation of clinical competence in medical residents is a complex procedure. Teachers need reliable and valid instruments to evaluate objectively the, clinical competence. The aim of this study was to determine the reliability and validity of an instrument designed to evaluate the clinical competence of medical residents. We designed an instrument taking into consideration every part of the clinical method, and three different levels of competence were determined for each one. The instrument was examined with regards to the clarity, pertinence and sufficiency of each clinical indicator by five expert pediatricians. The instrument was finally constituted by 11 indicators. Each resident was evaluated independently by three pediatricians. A total of 651 measurements were done in 234 residents. The instrument distinguished between extreme groups, had a value of Cronbach's alpha of 0.778 and the factorial analysis set apart two factors: clinical competence and complementary com...
Gaceta médica de México
Pediatric patients with malignant gliomas and same histological diagnosis respond distinctly to t... more Pediatric patients with malignant gliomas and same histological diagnosis respond distinctly to treatment. It is thus necessary to determine other factors that may influence the response to treatment and survival. Over expression of the Ki67 protein has been associated with poor treatment response. The aim of this study was to determine if the expression of this antigen influences survival of patients treated for malignant gliomas in the CMN SXXI Pediatrics Hospital. We included patients with anaplasic astrocitoma or glioblastoma multiforme seen at our hospital between 1995 and 2005. We determined the expression of Ki67 by immunohistochemistry and correlated the findings with tumor histology and patient survival. Of the 21 patients studied, 12 overexpressed antigen Ki67. There was no significant association between over expression of Ki67 and survival, although we observed a clinical association. Over expression of Ki67 correlated with more aggressive histology. Being under the age ...
Gaceta médica de México
Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the lit... more Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the literature. In Mexico it is less frequent, fallen to 8th place. Our objective was to analyze our experience and compare it with the one reported in other countries. We included all patients admitted to our hospital during the previous five years and who had not received any treatment. Patients with stages I, II, and IV received cyclophosphamide and epirrubicin. Patients with stages were III and IV received the same chemotherapy alternating with cisplatinum., ifosfamide and etoposide during 12 months as well as massive doses of 131-MIBG and surgical ablation of the remaining tumor when possible. We included 30 patients, 25 with initial presentation in the abdomen. Five were in early stages and 20 (70%) were advanced with an overall survival of 100% and 27% at 5 years respectively. When analyzed by age, 40% were 12 months of age and 60% older, with survival of 100% and 27% in the same period,...
Archives of medical research, 1998
Medulloblastoma represents 20% of all tumors of the central nervous system. Patients with partial... more Medulloblastoma represents 20% of all tumors of the central nervous system. Patients with partial resection of the tumor and those with extension into the neuraxis at diagnosis have been identified as high-risk patients. The objective of our study was to determine tumor response, survival rates and toxicity with a new scheme of treatment with carboplatin, etoposide and radiotherapy. All patients received chemotherapy with carboplatin and etoposide every 4 weeks for four courses, hyperfractionated radiotherapy, and another four courses of the above chemotherapy scheme. Tumor response was classified, and global and disease-free survival rates were calculated according to the actuarial survival method. A total of 26 patients were included, with a median age of 6.9 years. Nineteen achieved complete response after the first four courses of chemotherapy, and two more had a complete response after radiotherapy. A total of seven children have died, three of whom did not respond to initial t...
Body Image, 2015
Several studies have demonstrated that men express body dissatisfaction differently than women. A... more Several studies have demonstrated that men express body dissatisfaction differently than women. Although specific instruments that address body dissatisfaction in men have been developed, only a few have been validated in Latin-American male populations. The aim of this study was to reassess the factor structure of the Spanish versions of the Drive for Muscularity Scale (DMS-S) and the Male Body Attitudes Scale (MBAS-S) in an Argentinian sample. A cross-sectional study was conducted among 423 male students to examine: the factorial structure (confirmatory factor analysis), the internal consistency reliability, and the concurrent, convergent and discriminant validity of both scales. Results replicated the two factor structures for the DMS-S and MBAS-S. Both scales showed excellent levels of internal consistency, and various measures of construct validity indicated that the DMS-S and MBAS-S were acceptable and valid instruments to assess body dissatisfaction in Argentinian males.
Behavioral Psychology/Psicologia Conductual
A psychoeducational intervention programme for relatives of patients with an eating disorder is d... more A psychoeducational intervention programme for relatives of patients with an eating disorder is described. This pilot study examined the acceptability of the programme among 15 caregivers and whether their difficulties and distress involved in this role changed after intervention. Impact on the 14 eating disorder patients with was also explored. Assessments were undertaken at baseline (T0), at the end of the workshops (T1) and 3 months later (T2). After the intervention programme, relatives’ subjective caregiving experience, their levels of expressed emotion and distress improved. Patients’ recovery process was also positively affected –dysfunctional eating behaviours and affective symptoms decreased. These changes were maintained over time. The programme was highly valued by the carers, who expressed to be very satisfied and to have learnt to better recognise and understand the symptoms. The intervention presumes to be beneficial for both caregivers and patients, although results s...
The results of a meta-analytic study on the nature of body-image disturbance associated with eati... more The results of a meta-analytic study on the nature of body-image disturbance associated with eating disorders are reported. A total of 83 independent primary studies were admitted, all published between 1970 and 1998, and fulfilling the previouslyestablished selection criteria. The studies produced 238 estimations of effect size, measured as d index. Degree of disturbance of the image was 0.545 for anorexia, 1.019 for bulimia and 1.185 for bulimarexia. However, the analysis revealed great heterogeneity across studies. The factor most frequently associated is the way the disturbance is assessed. The attitude measures, which include cognitive-affective components, show greater average values than the perceptual measures. Also analyzed was the influence of other moderating variables, such as type of instructions, patient status or diagnosis procedure. Alternative explanations of the findings and clinical implications are discussed.
The Spanish Journal of Psychology, 2013
A meta-analysis was conducted to reach a pooled estimate of the diagnostic accuracy of the SCOFF.... more A meta-analysis was conducted to reach a pooled estimate of the diagnostic accuracy of the SCOFF. The 15 selected studies represented a total of 882 cases and 4350 controls. The main criterion for inclusion was that the primary study had provided diagnostic classification with both a diagnostic reference and with the SCOFF (with five items and a cut-off point of two). The pooled estimates were .80 (sensitivity) and .93 (specificity). The moderator variables gender and type of measure for the diagnostic reference (interview versus psychometric tests) account for part of the observed variability. For diagnostic references based on interviews the estimate of the efficacy improves significantly. For the studies that match this criterion the sensitivity is .882 and the specificity .925 (diagnostic odds ratio, 92.19). The main conclusion was that the five questions of the SCOFF constitute a very useful screening tool, in several languages; it is highly recommended for screening purposes.
Background. Depression and anxiety are common among medical residents. Coping strategies are cogn... more Background. Depression and anxiety are common among medical residents. Coping strategies are cognitive and conductual efforts in order to manage stress and specific individual demands. The use of active strategies has been associated with a lower frequency of anxiety and depression. Our objective was to determine if there is an association between depression and anxiety and the coping strategies used by medical residents.
Revista médica del Instituto Mexicano del Seguro Social, 2014
Gastroesophageal reflux after congenital diaphramatic hernia surgical correction occurs in up to ... more Gastroesophageal reflux after congenital diaphramatic hernia surgical correction occurs in up to 89 % of patients, out of which 20 to 30 % will require surgical management. Identification of risk factors for the development of this complication might allow for a Nissen fundoplication to be performed at the sime surgical time in those requiring it. The purpose of this research was to identify those factors in children with diaphragmatic hernia surgery. A case-control study was conducted, where patients with diaphragmatic hernia surgery treated between 2006 and 2011 were included. Patients with severe gastroesophageal reflux were regarded as the cases, whereas those who did not develop it over the 1-year follow up were the controls. Nine patients developed severe gastroesophageal reflux after the diaphragmatic hernia surgery. A large size of the hernia, it containing 4 or more organs, 10 days or more of ventilatory support requirement after the surgery or high mechanical ventilation v...
Archives of Medical Research, 2008
Background. Emesis and nausea are common adverse effects of chemotherapy. Consequences include de... more Background. Emesis and nausea are common adverse effects of chemotherapy. Consequences include dehydration, acute renal failure, esophageal rupture, electrolyte imbalance and undernutrition, among others. First-generation 5-HT3 antagonists significantly reduce these symptoms but are expensive and require administration every 8e12 h. Palonosetron, a second generation 5-HT3 antagonist has proven better results in adult populations. Other benefits include a one-dose administration with effect for up to 7 days and a lower treatment cost. No clinical studies have evaluated the safety and efficacy of palonosetron in children. Methods. Prior to every course, patients were randomized to receive palonosetron or ondansetron. Patients or guardians recorded the number of emetic events and the intensity of nausea over a 7-day period. They also reported any possible adverse effects. Statistical analysis included c 2 test, relative risk, and Student's t test. Results. Fifty courses were analyzed for each group. There was a significant reduction in emesis on the first 3 days and in the intensity of nausea in the first four days in the palonosetron group. There was an increased risk of presenting emesis and nausea in the acute phase when treated with ondansetron. No adverse effects were reported. The cost of treatment was also reduced when using palonosetron. Conclusions. Palonosetron is a safe and effective antiemetic treatment in children, as well as being cost effective.
Boletín médico del …, 2005
Dirección de Educación e Investigación en Salud, UMAE, Hospital de Pediatría, Centro Médico Nacio... more Dirección de Educación e Investigación en Salud, UMAE, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D. F., México. ... Solicitud de sobretiros: Dra.Ana Carolina Sepúlveda Vildósola, Unidad de Educación, ...
Revista médica del Instituto Mexicano del Seguro Social, 2014
Music has been used as adjuvant therapy for anxiety and it is based on scientific principles. Ton... more Music has been used as adjuvant therapy for anxiety and it is based on scientific principles. Tone, rhythm, harmony and time are crucial for its efficacy. Chemotherapy treatment frequently produces important stress in pediatric patients. This may delay treatment occasionally. Our objective was to determine if adjuvant therapy with music reduces anxiety in pediatric oncologic patients under ambulatory chemotherapy. Time series design. We included patients from 8 to 16 years of age who received ambulatory intravenous chemotherapy at the Hospital de Pediatría, Centro Médico Nacional Siglo XXI. They received treatment as usual on the first day, and music therapy during the second day of chemotherapy. A visual scale was used to categorize the level of anxiety prior and after treatment on both days. We included 22 patients. All patients experienced both moderate and high levels of anxiety prior to chemotherapy treatment on both days. There was a statistically significant reduction of anxi...
Archives of Medical Research, 2007
Revista De Psicopatologia Y Psicologia Clinica, Apr 1, 2013
Resumen: El estudio analiza la relación entre feminidad y conductas alimentarias inadecuadas en m... more Resumen: El estudio analiza la relación entre feminidad y conductas alimentarias inadecuadas en mujeres estudiantes de danza. El Eating Attitudes Test y el Conformity to the Feminine Norms Inventory fueron administrados a 50 estudiantes de grado medio y superior de danza y 75 estudiantes de bachiller y universitarios. Los resultados indican que el grupo de estudiantes de danza tenía un índice de masa corporal más bajo, estaba más satisfecho con su peso y presentaba con menor frecuencia conductas alimentarias inadecuadas relacionadas con los trastornos alimentarios (TA) que el grupo de estudiantes universitarios. Además, las estudiantes de danza con mayor riesgo de presentar conductas alimentarias inadecuadas se conformaban en mayor grado con la feminidad. La importancia de examinar las variables asociadas con el riesgo de TA, incluyendo la identificación con los roles de género, podría ser un paso adelante para mejorar la salud y la calidad de vida de las mujeres jóvenes.
Clinica Y Salud Num 1 Vol 15, 2015
... Variable Categoría Nº DE EFECTOS Medidas de imagen corporal Perceptivas cuerpo entero 42 efec... more ... Variable Categoría Nº DE EFECTOS Medidas de imagen corporal Perceptivas cuerpo entero 42 efectos (17.6%) Perceptivas cuerpo partes 53 efectos (22.3%) Actitudinal peso/forma 24 efectos (10.1%) Actitudinal global 119 efectos (50%) ...
Revista medica del Instituto Mexicano del Seguro Social
The prevalence of medical discontent is approximately 4%. Factors such as gender, age, type of sp... more The prevalence of medical discontent is approximately 4%. Factors such as gender, age, type of specialization, disillusion with the profession and economical factors have been identified among graduated medical doctors. Residents mentioned educational strategies as an additional factor of discomfort. To identify the prevalence and factors that influence on resident's discontent during their pediatric training program. The principal motives of dissatisfaction during the period of training in pediatric residence were identified using the semantic nets technique. Prevalence of dissatisfaction was 3.1%. The principal motives were: educational strategies, duration of medical career, work overload, hierarchical systems and abuse. Prevalence of dissatisfaction during a medical residence is similar to that reported in graduated pediatricians, and occurs during the first two years of residence. Educational strategies were one of the principal causes of discontent, and other local factors...
International Journal of Eating Disorders, 2015
Studies using traditional screening instruments tend to report a lower prevalence of eating disor... more Studies using traditional screening instruments tend to report a lower prevalence of eating disorders (EDs) in men than is observed in women. It is therefore unclear whether such instruments are valid for the assessment of ED in males. Lack of a formal diagnostic definition of muscle dysmorphia syndrome (MD) makes it difficult to identify men at risk. The study aimed to assess the prevalence of ED and MD in male university students of Buenos Aires. A cross-sectional, two-stage, representative survey was of 472 male students from six different schools in Buenos Aires, mostly aged between 18 and 28 years. The first stage involved administration of self-report questionnaires (Eating Attitude Test-26; scores ≥15 indicate "at risk" status). In Stage 2 students at risk of developing EDs were evaluated with a clinical interview, the Eating Disorder Examination (EDE; 12th edition). Two control students were interviewed for every at risk student. The prevalence of EDs among university male students was 1.9% (n = 9). All participants with an ED presented with illness classified as eating disorder not otherwise specified (EDNOS). Using the Drive for Muscularity Scale (DMS) with a 52-point threshold we identified possible MD in 6.99% (n = 33) of the sample. The prevalence of ED detected in this study is comparable with previous findings in male populations, and below that observed in female populations. However, the prevalence of possible cases of MD resembles the total rate of EDs in women. Characteristics associated with EDs and MD in men are also discussed. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015).
Revista medica del Instituto Mexicano del Seguro Social
To determine the risk factors associated with recurrent retinal detachment in patients vitrectomi... more To determine the risk factors associated with recurrent retinal detachment in patients vitrectomized. Case-control study nested in a cohort. We included patients with a diagnosis of rhegmatogenous retinal detachment treated with vitrectomy for one year, with a six months follow-up. We monitored the presence of incident event in the emergency department, and the examination room. Statistical analysis was performed by descriptive statistics (median, minimum and maximum) and inferential statistics (chi-squared test, Cox regression, Kaplan-Meier). A population of 94 patients with a median age of 55 years (21-83) was analyzed. The silicone was the most widely used type of tamponade in 62 patients (66 %) and recurrent retinal detachment occurred in 19 cases (20 %). In the relation between the non-relapse group and the relapse group, the statistically significant variable was the use of silicone (p = 0.05, OR = 0.03, 0.013-0.98), wich had a lower probability of recurrent detachment compare...
Revista médica del Instituto Mexicano del Seguro Social
The evaluation of clinical competence in medical residents is a complex procedure. Teachers need ... more The evaluation of clinical competence in medical residents is a complex procedure. Teachers need reliable and valid instruments to evaluate objectively the, clinical competence. The aim of this study was to determine the reliability and validity of an instrument designed to evaluate the clinical competence of medical residents. We designed an instrument taking into consideration every part of the clinical method, and three different levels of competence were determined for each one. The instrument was examined with regards to the clarity, pertinence and sufficiency of each clinical indicator by five expert pediatricians. The instrument was finally constituted by 11 indicators. Each resident was evaluated independently by three pediatricians. A total of 651 measurements were done in 234 residents. The instrument distinguished between extreme groups, had a value of Cronbach's alpha of 0.778 and the factorial analysis set apart two factors: clinical competence and complementary com...
Gaceta médica de México
Pediatric patients with malignant gliomas and same histological diagnosis respond distinctly to t... more Pediatric patients with malignant gliomas and same histological diagnosis respond distinctly to treatment. It is thus necessary to determine other factors that may influence the response to treatment and survival. Over expression of the Ki67 protein has been associated with poor treatment response. The aim of this study was to determine if the expression of this antigen influences survival of patients treated for malignant gliomas in the CMN SXXI Pediatrics Hospital. We included patients with anaplasic astrocitoma or glioblastoma multiforme seen at our hospital between 1995 and 2005. We determined the expression of Ki67 by immunohistochemistry and correlated the findings with tumor histology and patient survival. Of the 21 patients studied, 12 overexpressed antigen Ki67. There was no significant association between over expression of Ki67 and survival, although we observed a clinical association. Over expression of Ki67 correlated with more aggressive histology. Being under the age ...
Gaceta médica de México
Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the lit... more Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the literature. In Mexico it is less frequent, fallen to 8th place. Our objective was to analyze our experience and compare it with the one reported in other countries. We included all patients admitted to our hospital during the previous five years and who had not received any treatment. Patients with stages I, II, and IV received cyclophosphamide and epirrubicin. Patients with stages were III and IV received the same chemotherapy alternating with cisplatinum., ifosfamide and etoposide during 12 months as well as massive doses of 131-MIBG and surgical ablation of the remaining tumor when possible. We included 30 patients, 25 with initial presentation in the abdomen. Five were in early stages and 20 (70%) were advanced with an overall survival of 100% and 27% at 5 years respectively. When analyzed by age, 40% were 12 months of age and 60% older, with survival of 100% and 27% in the same period,...
Archives of medical research, 1998
Medulloblastoma represents 20% of all tumors of the central nervous system. Patients with partial... more Medulloblastoma represents 20% of all tumors of the central nervous system. Patients with partial resection of the tumor and those with extension into the neuraxis at diagnosis have been identified as high-risk patients. The objective of our study was to determine tumor response, survival rates and toxicity with a new scheme of treatment with carboplatin, etoposide and radiotherapy. All patients received chemotherapy with carboplatin and etoposide every 4 weeks for four courses, hyperfractionated radiotherapy, and another four courses of the above chemotherapy scheme. Tumor response was classified, and global and disease-free survival rates were calculated according to the actuarial survival method. A total of 26 patients were included, with a median age of 6.9 years. Nineteen achieved complete response after the first four courses of chemotherapy, and two more had a complete response after radiotherapy. A total of seven children have died, three of whom did not respond to initial t...
Body Image, 2015
Several studies have demonstrated that men express body dissatisfaction differently than women. A... more Several studies have demonstrated that men express body dissatisfaction differently than women. Although specific instruments that address body dissatisfaction in men have been developed, only a few have been validated in Latin-American male populations. The aim of this study was to reassess the factor structure of the Spanish versions of the Drive for Muscularity Scale (DMS-S) and the Male Body Attitudes Scale (MBAS-S) in an Argentinian sample. A cross-sectional study was conducted among 423 male students to examine: the factorial structure (confirmatory factor analysis), the internal consistency reliability, and the concurrent, convergent and discriminant validity of both scales. Results replicated the two factor structures for the DMS-S and MBAS-S. Both scales showed excellent levels of internal consistency, and various measures of construct validity indicated that the DMS-S and MBAS-S were acceptable and valid instruments to assess body dissatisfaction in Argentinian males.
Behavioral Psychology/Psicologia Conductual
A psychoeducational intervention programme for relatives of patients with an eating disorder is d... more A psychoeducational intervention programme for relatives of patients with an eating disorder is described. This pilot study examined the acceptability of the programme among 15 caregivers and whether their difficulties and distress involved in this role changed after intervention. Impact on the 14 eating disorder patients with was also explored. Assessments were undertaken at baseline (T0), at the end of the workshops (T1) and 3 months later (T2). After the intervention programme, relatives’ subjective caregiving experience, their levels of expressed emotion and distress improved. Patients’ recovery process was also positively affected –dysfunctional eating behaviours and affective symptoms decreased. These changes were maintained over time. The programme was highly valued by the carers, who expressed to be very satisfied and to have learnt to better recognise and understand the symptoms. The intervention presumes to be beneficial for both caregivers and patients, although results s...
The results of a meta-analytic study on the nature of body-image disturbance associated with eati... more The results of a meta-analytic study on the nature of body-image disturbance associated with eating disorders are reported. A total of 83 independent primary studies were admitted, all published between 1970 and 1998, and fulfilling the previouslyestablished selection criteria. The studies produced 238 estimations of effect size, measured as d index. Degree of disturbance of the image was 0.545 for anorexia, 1.019 for bulimia and 1.185 for bulimarexia. However, the analysis revealed great heterogeneity across studies. The factor most frequently associated is the way the disturbance is assessed. The attitude measures, which include cognitive-affective components, show greater average values than the perceptual measures. Also analyzed was the influence of other moderating variables, such as type of instructions, patient status or diagnosis procedure. Alternative explanations of the findings and clinical implications are discussed.
The Spanish Journal of Psychology, 2013
A meta-analysis was conducted to reach a pooled estimate of the diagnostic accuracy of the SCOFF.... more A meta-analysis was conducted to reach a pooled estimate of the diagnostic accuracy of the SCOFF. The 15 selected studies represented a total of 882 cases and 4350 controls. The main criterion for inclusion was that the primary study had provided diagnostic classification with both a diagnostic reference and with the SCOFF (with five items and a cut-off point of two). The pooled estimates were .80 (sensitivity) and .93 (specificity). The moderator variables gender and type of measure for the diagnostic reference (interview versus psychometric tests) account for part of the observed variability. For diagnostic references based on interviews the estimate of the efficacy improves significantly. For the studies that match this criterion the sensitivity is .882 and the specificity .925 (diagnostic odds ratio, 92.19). The main conclusion was that the five questions of the SCOFF constitute a very useful screening tool, in several languages; it is highly recommended for screening purposes.