Teaching medical statistics to undergraduate medical students: what is taught and what is really useful for a medical professional? A report of the Education Committee of the Italian Society of Medical Statistics and Clinical Epidemiology (SISMEC)

Background: There is a large heterogeneity among the courses of medical statistics in Italian Medical Schools.  Aims: (1) To describe issues that are dealt with in the statistics undergraduate medical courses in Italian medical Schools. (2) To investigate which methodological topics are deemed as more useful for the education of undergraduate medical students by clinical teachers.  Methods: (1) An online questionnaire, covering the qualifying teaching issues of medical statistics, was sent to all academic biostatisticians, asking what they were teaching to undergraduate medical students. The reference year was 2015-2016. Undergraduate medical courses were the statistical units. (2) A second survey involved teachers of other medical disciplines with institutional roles, asking to score the usefulness for medical education of a number of topics concerning medical statistics, on a 5-point Likert scale. Only descriptive analyses were performed.  Results: Fifty-two (96%) case report forms (CRF) were returned from teachers of medical statistics. Most statistical and epidemiological topics were taught except comparison of >2 groups, impact of biases and standardization of rates. Conversely, issues of clinical epidemiology were neglected in about half of degree courses.  Thirty-three (31%) CRFs were returned from clinical teachers. The percentage of issues deemed very useful or essential ranged from 57% to 94%, with higher scores for those referring to critical assessment of the literature.  Conclusions: More extensive coverage of clinical epidemiology issues is needed to meet the demand of physicians, as responsible consumers of quantitative research. As biostatisticians we should operate to increase the homogeneity of medical statistics teaching in medical undergraduates’ educatio

Evaluación de metodologías de planeación estratégica en pymes del sector confección: estudio de caso

In the complexity of SMEs in their current context, evaluating strategic planning methodologies has been an effective tool to find strategic solutions that enable them to be more profitable and competitive. Therefore, this article evaluates a strategic planning methodology at an SME in the clothing sector in Antioquia, Colombia. Such evaluation was implemented in 3 stages: initial diagnosis, diagnosis of micro and macroeconomic variables, and mission and strategic framework. Semi-structured interviews with employees and managers as well as direct observation were used to collect information. The results indicate that their management of strategic planning is not the most adequate due to a lack of knowledge about an efficient model and managers’ little interest. Additionally, the evaluation showed that the tool can be implemented when the company defines its strategic planning. As a result of the constant changes SMEs undergo, cross-sectional studies should be conducted to design methodologies that can be adapted to their current structure. Planning models framed in their real context more greatly consolidate managerial structures and generate more competitive advantages. The tool is defined by internal and external factors.En el marco de la complejidad que presentan las pymes en su contexto actual, la evaluación de metodologías de planeación estratégica se ha convertido en una herramienta efectiva en la búsqueda de soluciones estratégicas que le permitan ser más rentables y competitivas. Bajo esta perspectiva, este artículo propone la evaluación de una metodología de planeación en una pyme del sector confección en Antioquia. El desarrollo metodológico se ejecutó en 3 fases: diagnóstico inicial, diagnóstico de variables micro - macroeconómicas y marco misional y estratégico. La información se obtuvo mediante entrevistas semiestructuradas a empleados y directivos, y a la observación directa. Los resultados indicaron que la gestión en la planeación no es la más adecuada y radica en el desconocimiento de un modelo eficiente y el poco interés directivo. Además, la evaluación mostró que la herramienta es viable cuando la empresa construye el proceso de planeación. Se detectó que, de acuerdo al constante cambio que presentan las pymes, es preciso la realización de investigaciones de tipo longitudinal que permitan diseñar metodologías que se adapten a su estructura actual. Los modelos de planeación que estén enmarcados a su contexto real, consolidan en mayor nivel la estructuración administrativa y la generación de ventajas competitivas. La herramienta está en función del análisis de factores internos y externos

Iron (II) citrate complex as a food supplement: Synthesis, characterization and complex stability

Iron deficiency represents a widespread problem for a large part of the population, especially for women, and has received increasing attention in food/supplement research. The contraindications of the iron supplements commercially available (e.g., imbalances in the levels of other essential nutrients, low bioavailability, etc.) led us to search for a possible alternative. In the present work, a rapid and easy method to synthetize a solid iron (II) citrate complex from iron filings and citric acid was developed to serve, eventually, as a food supplement or additive. In order to state its atomic composition and purity, an assortment of analytical techniques was employed (e.g., combustion analysis, thermogravimetry, X-ray diffractometry, UV/Vis spectrophotometry, etc.). Results demonstrate that the synthesized crystalline solid corresponds to the formula FeC6H6O7∙H2O and, by consequence, contains exclusively iron (II), which is an advantage with respect to existing commercial products, because iron (II) is better absorbed than iron (III) (high bioavailability of iron)

Mothers’ conceptions about excess weight in infancy and the nutritional status of their children

OBJECTIVE: To analyze maternal conceptions about excess weight in infancy and the nutritional status of their preschool-aged children. METHODS: A mixed, exploratory study was performed using semi-structured interviews. Two study groups were defined: a group of 16 mothers of children with excess weight and a group of 15 mothers of eutrophic children. The interviews were submitted to content analysis using CHIC software (Classification Hiérarchique Implicative et Cohésitive¯). RESULTS: The mothers of children with excess weight tended to conceive thin children as malnourished, while those of normal weight children emphasized the influence of family and genetics as determinants of a child’s nutritional status. Although there was a certain consensus among the mothers that an unhealthy diet contributes to the risk of a child developing excess weight, the concept of genetics as a determinant of a child’s nutritional status was also present in the dialogue from the mothers of both groups. This result indicates a lack of clarity regarding the influence of eating behavior and family lifestyle on weight gain and the formation of a child’s eating habits. Both groups indicated that the mother has a decisive role in the eating habits of her child; however, the mothers of children with excess weight did not seem to take ownership of this concept when addressing the care of their own children. CONCLUSION: Differences in conceptions, including taking ownership of care, may contribute to the development of excess weight in preschool-aged children

Predictivity of clinical, laboratory and imaging findings in diagnostic definition of palpable thyroid nodules. A multicenter prospective study

Abstract PURPOSE: To assess the role of clinical, biochemical, and morphological parameters, as added to cytology, for improving pre-surgical diagnosis of palpable thyroid nodules. METHODS: Patients with a palpable thyroid nodule were eligible if surgical intervention was indicated after a positive or suspicious for malignancy FNAC (TIR 4-5 according to the 2007 Italian SIAPEC-IAP classification), or two inconclusive FNAC at a 653 months interval, or a negative FNAC associated with one or more risk factor. Reference standard was histological malignancy diagnosis. Likelihood ratios of malignancy, sensitivity, specificity, negative (NPV), and positive predictive value (PPV) were described. Multiple correspondence analysis (MCA) and logistic regression were applied. RESULTS: Cancer was found in 433/902 (48%) patients. Considering TIR4-5 only as positive cytology, specificity, and PPV were high (94 and 91%) but sensitivity and NPV were low (61 and 72%); conversely, including TIR3 among positive, sensitivity and NPV were higher (88 and 82%) while specificity and PPV decreased (52 and 63%). Ultrasonographic size 653\u2009cm was independently associated with benignity among TIR2 cases (OR of malignancy 0.37, 95% CI 0.18-0.78). In TIR3 cases the hard consistency of small nodules was associated with malignity (OR: 3.51, 95% CI 1.84-6.70, p\u2009<\u20090.001), while size alone, irrespective of consistency, was not diagnostically informative. No other significant association was found in TIR2 and TIR3. CONCLUSIONS: The combination of cytology with clinical and ultrasonographic parameters may improve diagnostic definition of palpable thyroid nodules. However, the need for innovative diagnostic tools is still high

Interaction of Vault Particles with Estrogen Receptor in the MCF-7 Breast Cancer Cell

A 104-kD protein was coimmunoprecipitated with the estrogen receptor from the flowtrough of a phosphocellulose chromatography of MCF-7 cell nuclear extract. mAbs to this protein identified several cDNA clones coding for the human 104-kD major vault protein. Vaults are large ribonucleoprotein particles of unknown function present in all eukaryotic cells. They have a complex morphology, including several small molecules of RNA, but a single protein species, the major vault protein, accounts for >70% of their mass. Their shape is reminiscent of the nucleopore central plug, but no proteins of known function have been described to interact with them. Western blot analysis of vaults purified on sucrose gradient showed the presence of estrogen receptor co-migrating with the vault peak. The AER317 antibody to estrogen receptor coimmunoprecipitated the major vault protein and the vault RNA also in the 20,000 g supernatant fraction. Reconstitution experiments of estrogen receptor fragments with the major vault protein mapped the site of the interaction between amino acids 241 and 280 of human estrogen receptor, where the nuclear localization signal sequences are located. Estradiol treatment of cells increased the amount of major vault protein present in the nuclear extract and coimmunoprecipitated with estrogen receptor, whereas the anti-estrogen ICI182,780 had no effect. The hormone-dependent interaction of vaults with estrogen receptor was reproducible in vitro and was prevented by sodium molybdate. Antibodies to progesterone and glucocorticoid receptors were able to coimmunoprecipitate the major vault protein. The association of nuclear receptors with vaults could be related to their intracellular traffic

Bioactive Metabolite Survey of Actinobacteria Showing Plant Growth Promoting Traits to Develop Novel Biofertilizers

The use of chemical fertilizers and pesticides has caused harmful impacts on the environment with the increase in economic burden. Biofertilizers are biological products containing living microorganisms capable of improving plant growth through eco-friendly mechanisms. In this work, three actinobacterial strains Streptomyces violaceoruber, Streptomyces coelicolor, and Kocuria rhizophila were characterized for multiple plant growth promoting (PGP) traits such as indole acetic acid production, phosphate solubilization, N-2-fixation, and drought and salt tolerance. Then, these strains were investigated for their secreted and cellular metabolome, revealing a rich arsenal of bioactive molecules, including antibiotics and siderophores, with S. violaceoruber being the most prolific strain. Furthermore, the in vivo assays, performed on tomato (Solanum lycopersicum L.), resulted in an improved germination index and the growth of seedlings from seeds treated with PGP actinobacteria, with a particular focus on S. violaceoruber cultures. In particular, this last strain, producing volatile organic compounds having antimicrobial activity, was able to modulate volatilome and exert control on the global DNA methylation of tomato seedlings. Thus, these results, confirming the efficacy of the selected actinobacteria strains in promoting plant growth and development by producing volatile and non-volatile bioactive molecules, can promote eco-friendly alternatives in sustainable agriculture

Colistin and rifampicin compared with colistin alone for the treatment of serious infections due to extensively drug-resistant Acinetobacter baumannii: A multicenter, randomized clinical trial

Background. Extensively drug-resistant (XDR) Acinetobacter baumannii may cause serious infections in critically ill patients. Colistin often remains the only therapeutic option. Addition of rifampicin to colistin may be synergistic in vitro. In this study, we assessed whether the combination of colistin and rifampicin reduced the mortality of XDR A. baumannii infections compared to colistin alone. Methods. This multicenter, parallel, randomized, open-label clinical trial enrolled 210 patients with life-threatening infections due to XDR A. baumannii from intensive care units of 5 tertiary care hospitals. Patients were randomly allocated (1:1) to either colistin alone, 2 MU every 8 hours intravenously, or colistin (as above), plus rifampicin 600 mg every 12 hours intravenously. The primary end point was overall 30-day mortality. Secondary end points were infection-related death, microbiologic eradication, and hospitalization length. Results. Death within 30 days from randomization occurred in 90 (43%) subjects, without difference between treatment arms (P = .95). This was confirmed by multivariable analysis (odds ratio, 0.88 [95% confidence interval, .46-1.69], P = .71). A significant increase of microbiologic eradication rate was observed in the colistin plus rifampicin arm (P = .034). No difference was observed for infection-related death and length of hospitalization. Conclusions. In serious XDR A. baumannii infections, 30-day mortality is not reduced by addition of rifampicin to colistin. These results indicate that, at present, rifampicin should not be routinely combined with colistin in clinical practice. The increased rate of A. baumannii eradication with combination treatment could still imply a clinical benefi

Estratégia de Saúde da Família e prevalência de anemia em mulheres de uma região urbana de alto Índice de Desenvolvimento Humano

Introduction: Iron deficiency anemia, a public health problem. Objective: To analyze the hemoglobin value and the prevalence of anemia in women of reproductive age, mothers of children enrolled in municipal nurseries in a municipality and a high Human Development Index in the Southeast region, in addition to related factors, including being attended by the Family Health Strategy. Methods:&nbsp;A cross-sectional study, in a sample of 230 women aged 15 to 49 years. Collection of data through standardized form. Weight, height, and hemoglobin concentration were measured. Results: The prevalence of anemia in women was 9.6% and the mean hemoglobin concentration was 14.6g/dL. In the bivariate analysis, showed association with anemia the variables: age, having some disease, obstetric intercurrences in the child's study and as a protection factor and to be in the program Family Health Strategy. In the binary logistic analysis, only being attended by the Family Health Strategy demonstrated a significant protective effect against anemia (OR=0,391, p&lt;0,05). Conclusion: Although there is a mild prevalence of anemia, according to World Health Organization criteria, in an urban area with a high Human Development Index, well-managed health care policies, the Family Health Strategy in particular, can contribute to further reduce the prevalence of this condition in the health of women of reproductive age.Introdução: Anemia ferropriva é um importante problema de saúde pública. Objetivo: Analisar o valor de hemoglobina e a prevalência de anemia em mulheres em idade reprodutiva, mães de filhos inscritos em creches municipais de um município com alto Índice de Desenvolvimento Humano, na região Sudeste, além de fatores a elas relacionados, incluindo serem atendidas pela Estratégia de Saúde da Família. Método: Trata-se de um estudo transversal com amostra constituída por 230 mulheres entre 15 e 49 anos de idade. A coleta de dados foi realizada por meio de formulário, abordando variáveis socioeconômicas e saúde materna. Verificaram-se: peso, estatura e dosagem da concentração da hemoglobina. Resultados: A prevalência de anemia nas mulheres foi de 9,6%, com média de concentração da hemoglobina de 14,6g/dL. Na análise bivariada, mostraram associação com anemia as variáveis: idade, ter alguma doença, intercorrências obstétricas na gestação da criança estudada e, como fator de proteção, estar no programa Estratégia de Saúde da Família. Na análise binária logística, apenas ser atendida pela Estratégia de Saúde da Família demonstrou ser significante efeito protetor frente à anemia (OR=0,391, p&lt;0,05). Conclusão: Apesar de haver uma prevalência leve de anemia, pelo critério da Organização Mundial da Saúde, em área urbana de alto Índice de Desenvolvimento Humano, políticas de atenção à saúde e bem conduzidas, a Estratégia de Saúde da Família em particular, podem contribuir para reduzir ainda mais a prevalência desse agravo na saúde das mulheres em idade reprodutiva