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Introducción: El aprendizaje autodirigido es una habilidad del estudiante que le permite obtener mayor desempeño académico a través de poner en práctica sus capacidades metacognitivas, motivacionales y conductuales, enfocadas en metas de adquisición de conocimientos y destrezas.Objetivo: Determinar la asociación del nivel de aprendizaje autodirigido con características sociodemográficas y académicas de estudiantes de medicina.Método: Se realizó una encuesta transversal comparativa en estudiantes de medicina, mediante la aplicación de la escala de autoevaluación del aprendizaje autodirigido y un cuestionario estructurado para recabar características sociodemográficas y académicas. También se efectuó un análisis con estadística descriptiva, pruebas de correlación, inferenciales y de asociación.Resultados: Se incluyeron en el estudio a 247 estudiantes de medicina con edad de 21.3 ± 1.9 años, 147 (51.4%) fueron de sexo femenino. La puntuación de aprendizaje autodirigido fue moderada en 116 (47.0%) estudiantes, y quienes tuvieron promedio superior a 9 alcanzaron puntuación de 120.1 ± 12.4 en comparación con 114.5 ± 12.5 de aquellos con promedio escolar de 8.00 a 8.99, y 110.7 ± 12.1 con los de 7.00 a 7.99 (p 0.05).Conclusiones: Estudiantes de medicina presentan desarrollo medio o semiestructurado de aprendizaje autodirigido, que se asoció con estatus académico y promedio escolar, pero no con características sociodemográficas ni grado académico.

Background and objective: Diabetic kidney disease (DKD) is the most common microvascular chronic complication of diabetes mellitus. Hyperbaric oxygen (HBO2) therapy will increase the partial pressure of oxygen (PaO2) and may improve cell repair processes, which can lead to better renal function. The objective of this study was to quantify the efficacy of adjuvant HBO2 to increase the glomerular filtration rate and urinary albumin excretion in diabetic patients, as well as determine its effectiveness to modify the clinical course of DKD. Materials and methods: An experimental study was performed on patients with stage 3 and 4 DKD. Twenty sessions of HBO2 or ambient air in a hyperbaric chamber were administered. Estimated glomerular filtration rate, urine albumin:creatinine ratio calculation and clinical stage stratification were made prior to and after HBO2 administration. A descriptive, inferential and clinical efficacy analysis was performed. Results: Urinary albumin/creatinine (UACR) mean values prior to HBO2 were 1452.9 ± 644.3 mg/g and decreased to 876.1 ± 504.0 mg/g at the end of the study (p=0.06). The patients in the control group showed a UACR mean of 2784.5 ± 2128.6 mg/g and 2861.4 ± 2424.2 mg/g at baseline and at the end of the study, respectively (p=0.82). Patients in the experimental/HBO2 group showed an estimated GFR of 27.3 ± 9.5 mL/min /1.73m2 before HBO2, with a 34.4 ± 6.9 mL/min/1.73m2 after treatment (p=0.017); control group eGFR was 30.1 ± 9.2 mL/min/1.73m2, decreasing to 22.2 ± 6.8 mL/min/1.73m2 (p=0.004). Relative risk 0.00, relative risk reduction -100%, absolute risk reduction -71.4%, 95% CI (-104.9% to -38.0%), NNT 1, 95% CI (1 to 3). Conclusions: Management with HBO2 for DKD was associated with decreased excretion urinary albumin, improved GFR and clinical stage of patients in stages 3 and 4 of kidney damage unlike those receiving ambient air.

Background In Mexico, 47.7% of newborns are breastfed within the first hour of life and 28.6% are exclusively breastfed until 6 months of age, which does not meet the WHO definition of successful breastfeeding. Attitudes are expressed through beliefs, emotions and intentions wich represent a link between attitude and behavior, that is, a strong predictor of behavior. Objetive: to determine the factors associated with the intention of breastfeeding in womeńs next pregnancy. Methods A cross-sectional, prospective, observational and comparative study was carried out. Women between 18 and 35 years old, residents from Veracruz in Mexico, were between July and December 2020. Virtual surveys were applied through social networks, using a non-probabilistic sampling, evaluating knowledge about breastfeeding through the application of the ‘Breastfeeding knowledge questionnaire' (Cronbach's Alpha 0.722) and social characteristics were also recorded. Results 1241 participants were included, with a mean age of 22.1 (± 3.5) years. The prevalence of the intention to exclusively breastfeed was 41.2%; the factors that registered a positive association for the intention to grant exclusive breastfeeding were the age between 18 and 25 years (OR 2.0 95%IC 1.4-2.9), high knowledge (OR 2.0 IC95%1.3-2.9), being single (OR 3.7, CI95% 2.4-5.6), studyng high school (OR 1.3, 95%CI 1.05-1.7), being students (OR 2.2, 95%CI 1.7-2.8), have medical service through social security (OR 1.4, 95%CI 1.1-1.7), know what is a breastfeeding room (OR 1.9 95%CI 1.5-2.4), as well as know different points of the law in support of lactation had OR values higher than 1, with p values Conclusions Age, knowledge about breastfeeding, marital status, scholarship, occupation, having medical attention for social security, not having children, knowing the legal aspects about breastfeeding in Mexico and knowing the concept of breastfeeding room are associated with the intention to exclusively breastfeed. Key messages Women who receive medical care in the public health system increase their intention to exclusively breastfeed in their next pregnancy. High knowledge about breastfeeding, the laws that support it, being young, single, and knowing what abreastfeeding room is all favor the intentions of giving exclusive breastfeeding.

Background In Mexico, 95.6% of children under 2 years of age are breastfed at least once in their lifetime; however, only 28.6% are exclusively breastfed and 40.2% are predominantly breastfed up to 6 months of age. Mothers who do not breastfeed their children or abandon breastfeeding before 6 months of age give reasons that suggest lack of knowledge or lack of support. Aim to determine the factors associated with a high or higher level of knowledge about breastfeeding in women in Veracruz, Mexico. Methods A cross-sectional, prospective, observational and comparative study was carried out. Women between 18 and 35 years old, from Veracruz, Mexico were included, between July to December 2020. Virtual surveys were applied through social networks, using a non-probabilistic sampling, evaluating knowledge about breastfeeding through the application of the ‘Breastfeeding knowledge questionnaire', and its interpretation is carried out at four levels of knowledge: poor, regular, high and very high (Cronbach's alpha of 0.722). Results 1241 participants were included. The patients showed high or greater knowledge in 1057 (85.1%) cases. Having school as the main source of information for breastfeeding, reported an Odds Ratio (OR) of 1.5 (95%CI 1.05-2.2) and having intentions to exclusively breastfeed in the next pregnancy had an OR of 1.7 (95% CI 12 .-2.4), while obtaining the information through friends, family or acquaintances had an OR of 0.6 (95% CI 0.4-0.8), both with p values 0.05; Conclusions The high level of knowledge is positively associated with the information received at school from while it is negatively associated with having family or friends as the main sources of information. Key messages The high level of knowledge is positively associated with the information received at school. The high level of knowledge is negatively associated with having family or friends as the main sources of information.

Introduction Within the current context in our Mexico, major states of violence for women have been manifested on a daily basis without having any more reason than being female. Veracruz is the first place in feminicides in Mexico with a rate of 3.44 per 100 thousand women. Research question: What is the intensity of the violence committed and victimization in the courtship of young students of the Upper Middle level in the Veracruz - Boca del Río area, according to their gender? Material and Methods A cross-sectional, prospective, observational and analytical study was carried out from December to February 2020. Middle-high school students from the Veracruz-Boca del Río region were included, who had a dating relationship and were excluded those who did not accept to participate. The variable “violence committed and victimization in courtship” was quantified with the CADRI instrument. The spss v22 software was used, Sudent's T was calculated for independent samples, with statistical significance p Results 741 students were included. There was a prevalence of violence committed of 86.2% and victimization of 89.2%. Of the total number of students who suffered and committed violence, women occupy 66.3% and 66.7% respectively. There is a difference in the intensity of violence between women and men in verbal-emotional violence (4.5 ± 4.2 vs. 3.4 ± 3.4), physical violence (0.6 ± 1.3 vs. 0.36 ± 3.6) and violence in general (5.7 ± 5.7 vs 4.3 ± 4.8) (p 0.05). The history of psychological and sexual violence in previous relationships, as well as sexual violence in daily life are more frequent in the female sex (p Conclusions The violence generated is more intense in women, however, they also have a history of having suffered violence more frequently in previous relationships and in their daily lives. Key messages Women suffer more aggressions at different stages of their lives, which may increase the risk to tolerate aggressions or be more aggressive or suffer mental health problems. We must study if the violence generated by women is a response to a previous aggression from their boyfriend.

Background At present, the legal status of abortion worldwide is maintained heterogeneously. In Mexico, its practice is allowed within the capital of the country and one more state, provided that it is before the 12th week, however in the rest of the country it is still classified as illegal. Research question: What are the factors associated with the modification of attitudes towards abortion? Methods An observational, prospective, cross-sectional and analytical study was conducted in Veracruz, Mexico between December 2019 and March 2020. University students from public and private schools were included, from the city of Veracruz-Boca del Río, selecting the participants through a non-probabilistic sampling. The Attitudes Abortion Questionnaire was applied to assess the attitudes provided, pro-selection, reproductive rights, health risk and legalization. The surveys were conducted through Google Forms® and were answered on that same platform. The results were collected and analyzed with the SPSS Statistic® program. Results 517 students were included. Private school students showed differences in pro-election attitudes when compared to public, students from urban areas had more pro-election attitudes and in favor of reproductive law compared to those from rural areas, having active sex life and having someone known to having performed induced abortion favors the attitude of pro-choice, reproductive rights and the legalization of abortion as a means of solution for its complications, and detracts from the position provided, in both situations (p Conclusions The social context still manifests itself uneven at the moment of having a posture and attitude with the legalization of induced abortion, being strong, independent of religion strong beliefs in a god. Key messages University students are in different positions before abortion according to their social and cultural context. The regulation of the abortion policy will have to contemplate the particular Mexican situation taking into account its social fabric and the moment in which it lives.

Background Veracruz is Mexico's second state with the highest number of HIV / AIDS cases. Identifying the factors that facilitate greater knowledge, a better attitude, self-efficacy and susceptibility could improve the way HIV/AIDS prevention and training activities are planned and executed. Research question: What are the characteristics that mark differences in knowledge, attitudes, self-efficacy and susceptibility on HIV in university students? Methods An observational, prospective, cross-sectional and analytical study was conducted in Veracruz, Mexico between June and December 2019. University students from public and private schools in Veracruz-Boca del Río were included, excluding those who did not agree to participate, selecting participants through non-probabilistic sampling. Through the application of surveys, in which students were requested the VIH/ SIDA-65 test was applied to assess attitudes, self-efficacy and susceptibility. The surveys were conducted through Google Forms® and were answered on that same platform. The results were collected and analyzed with the SPSS Statistic® program. Results 565 students were included, 62.8% were male, 98.6% cisgender and, 88.3% as heterosexual. Being a man, marks differences in neutral attitude (32.2 ± 18.0 vs. 29.0 ± 15.8) and susceptibility (48.95 ± 20.3 vs. 43.2 ± 18.2), non-heterosexual sexual orientation in positive attitude (4.5 ± 0.7 vs. 4.2 ± 1.1), active sex life in neutral attitude (32.0 ± 17.4 vs. 24.1 ± 12.1) and self-efficacy (89.1 ± 19.5 vs. 83.5 ± 22.0) all with values of p 0.5 Conclusions Among the university students, being a man, being non-heterosexual and having active sex life are factors that make a difference in attitude, self-efficacy and susceptibility to HIV / AIDS. Key messages We must improve pre-university reproductive health education, since it does not make a difference in knowledge and attitudes for HIV / AIDS. We consider it convenient to propose a reproductive health module to promote HIV-focused health in university students.

Introduction According to data from the World Health Organization (WHO), 3 out of 10 adolescents report that they suffer violence in dating. In the Mexican case, 76% of adolescents between 15 and 17 years have suffered 17% sexual and 15% physical psychological violence. In 2019, Veracruz registered in the first place of feminicide in Mexico with a rate of 3.44 per 100 thousand women Methods A cross-sectional, prospective, observational and analytical study was carried out from December to February 2020. Middle-high school students from the Veracruz-Boca del Río region were included, who had a dating relationship and were excluded those who did not accept to participate. The CADRI test was applied to quantify “violence committed and victimization in dating”. Results 741 students were included. There was a prevalence of violence committed of 86.2% and victimization of 89.2%. Being a woman, having active sex life, relationships over 12 months, living in a rural area, having a history of physical, psychological and sexual violence in previous relationships, daily life and in your family were the main factors associated with the violence committed, highlighting physical violence in previous relationships (OR 7.36 95% CI 1.8-31.6) (p Conclusions The violence generated and victimization share associated factors, the most important being women, having a history of physical, psychological and sexual violence in the family, daily life and previous relationships. Key messages Women suffer more aggressions at different stages of their lives, which may increase the risk to tolerate aggressions or be more aggressive or suffer mental health problems. We must study if the violence generated by women is a response to a previous aggression.

Introduction In the Mexican - American population, violence occurs between 10 and 40% of initial affective relationships. Veracruz is one of the main Mexican states that suffers violence and is the one with the largest number of femicides (3.44 per 100,000 women). Research question: what are the associated factors in the victimization in the courtship of young university students from the Veracruz - Boca del Río conurbation zone? Methods A cross-sectional, prospective, observational and analytical study was conducted from August to November 2019. University students enrolled in a higher education educational program in public and private universities of Veracruz-Boca del Río, who have had the minus a dating relationship and those who did not agree to participate were excluded. Violence in dating was quantified with the “Questionnaire on Violence in Dating (CUVINO)” (Alfa Cronbach 0.91). The spss v22 software was used to analyze the data. Results 680 participants were included, distributed in private schools (56.47%) and public schools (43.52%), with 444 (65.2%) women and 236 (34.7%) men. The prevalence of dating violence was 74.9%, however, only 21.6% of the participants considered having had such a relationship. The factors associated with dating violence were studying in a private school (OR = 0.62 IC95% 0.4-0.9), witnessing some act of violence in your family (OR = 1.47 IC95% 1.02-2.12), meeting a friend with a relationship violent (OR = 2.0 95% CI 1.4-2.9), believe that abuse exists in courtship (OR = 4.7 95% CI 2.9-7.4) and suspect that you may be in a violent relationship (OR = 4.67 95% CI 2.22- 9.83), while not witnessing any act of violence in your family (OR = 0.61 95% CI 0.4-0.8) is a protective factor to avoid violence in dating, all these values with p Conclusions Violence in dating is associated with behaviors of family members and friends of the violent. Key messages The social situation close to a person influences the violence allowed in their courtship. Young people normalize violence in a relationship, since many of them do not identify it when living it.

To determine whether gait and balance dysfunction are present in young urbanites exposed to fine particular matter PM2.5 ≥ annual USEPA standard, we tested gait and balance with Tinetti and Berg tests in 575 clinically healthy subjects, age 21.0±5.7y who were residents in Metropolitan Mexico City, Villahermosa and Reynosa. The Montreal Cognitive Assessment was also applied to an independent cohort n:76, age 23.3± 9.1y. In the 575 cohort, 75.4% and 34.4% had abnormal total Tinetti and Berg scores and high risk of falls in 17.2% and 5.7% respectively. BMI impacted negatively Tinetti and Berg performance. Gait dysfunction worsen with age and males performed worse than females. Gait and balance dysfunction were associated with mild cognitive impairment MCI (19.73%) and dementia (55.26%) in 57/76 and 19 cognitively intact subjects had gait and balance dysfunction. Seventy-five percent of urbanites exposed to PM2.5 had gait and balance dysfunction. For MMC residents-with historical documented Alzheimer disease (AD) and CSF abnormalities, these findings suggest Alzheimer Continuum is in progress. Early development of a Motoric Cognitive Risk Syndrome ought to be considered in city dwellers with normal cognition and gait dysfunction. The AD research frame in PM2.5 exposed young urbanites should include gait and balance measurements. Multicity teens and young adult cohorts are warranted for quantitative gait and balance measurements and neuropsychological and brain imaging studies in high vs low PM2.5 exposures. Early identification of gait and balance impairment in young air pollution-exposed urbanites would facilitate multidisciplinary prevention efforts for modifying the course of AD., Highlights • Exposure to air pollution is associated with gait and balance dysfunction. • Mexico City 575 urbanites 21.0±5.7y had abnormal Tinetti 75% and Berg 34%. • High risk of falls in 17% (Tinetti) and 5.7% (Berg) is of deep concern. • ♦Gait and balance dysfunction are associated with MCI and dementia scores. • Gait and balance dysfunction suggest Alzheimer Continuum is in progress.

Neonatal Hearing Screening and Early Intervention (NHSEI) is a screening program to evaluate all infants and identify those with hearing impairment. The objective of this work was to determine the factors associated with hearing loss in NHSEI program.Analytical cross-sectional study was performed. 234 infants were included in the NHSEI program, hearing was evaluated with transitory evoked otoacoustic emissions (TEOE) at frequencies of 1.5 to 4.5 kHz, and intensity of stimuli of 40-60 dB. The variables were: age from one to 28 days, sex, gestational age and perinatal history. Data was analyzed with descriptive statistics and binary logistic regression.The presence of risk factors in newborns resulted in significant omnibus test (p0.05) predicted value by Nagelkerke R square model of 77%. The background inherited family acquired infection, craniofacial abnormalities, low birth weight, respiratory distress at birth and genetic syndromes were factors significantly associated (p0.05) to hearing loss in infants.The incidence of hearing impairment in infants diagnosed by newborn hearing program was higher (5/234 newborns) than the reported in the literature.Introducción: el Tamiz Auditivo Neonatal e Intervención Temprana (TANIT) es un programa de cribado que consiste en evaluar a todos los neonatos para identificar discapacidades auditivas. El objetivo de este trabajo fue determinar los factores asociados a hipoacusia en neonatos, basados en el programa TANIT. Métodos: estudio analítico, transversal, en el que se incluyeron 234 neonatos en el programa TANIT. La audición se exploró evaluando las emisiones otoacústicas transitorias evocadas (EOAT) en frecuencias de 1.5 a 4.5 kHz, y los estímulos con intensidad de 40-60 dB. Las variables fueron: edad de uno a 28 días de nacido, sexo, edad gestacional y antecedentes perinatales. Los datos se analizaron con estadística descriptiva y regresión logística binaria. Resultados: la presencia de los factores de riesgo en los neonatos resultó significativa en la prueba de ómnibus (p0.05), valor de predicción por el modelo R cuadrado de Nagelkerke de 77%. Los antecedentes heredofamiliares, la infección adquirida, las anormalidades craneofaciales, el bajo peso, la dificultad respiratoria al nacer y los síndromes genéticos fueron factores que se asociaron de manera significativa (p0.05) a hipoacusia en neonatos. Conclusiones: la incidencia de deficiencia auditiva en recién nacidos diagnosticada mediante el programa de TANIT fue mayor a la reportada en la literatura (5/234 recién nacidos).

El objetivo del estudio es determinar la eficacia de modificar el estilo de vida en el riesgo cardiovascular de los prehipertensos (pacientes con presion arterial sistolica entre 120 y 139 mmHg y diastolica entre 80 y 89 mmHg). Se realizo un ensayo clinico aleatorizado en prehipertensos sometidos a programa de dieta, actividad fisica y sesiones educativas, y se lo comparo con las recomendaciones habituales. El riesgo cardiovascular se evaluo con las tablas de Framingham y se utilizo las pruebas de la c2, de la U de Mann-Whitney y de Friedman. La puntuacion de Framingham disminuyo en el grupo experimental de 5 (rango de -10 a 12) a 3,5 (-11 a 10) (p < 0,05) y la probabilidad de eventos cardiovasculares a 10 anos, de 5,29 ± 3,88 a 4,24 ± 2,86 (p < 0,05), RR = 0,3 (IC del 95%, 0,11-0,83), RRR = -69,8% (IC del 95%, -89% a -16,9%). En los controles no se modifico. La modificacion del estilo de vida disminuyo el riesgo cardiovascular en prehipertensos.

to assess the specificity and sensibility of the O'Sullivan test for gestational diabetes in early pregnancy.a pilot study in 50 women with low-risk of pregnancy, without history of alteration of glucose was done. The O'Sullivan test consisted in the administration of 50 g of glucose; glycemia was measured 60 minutes after, between weeks 14 and 23 and between weeks 24 and 28 of pregnancy. Value was considered positive with a glycemia = 140 mg/dL. We calculated sensitivity, specificity and predictive values.O'Sullivan test performed between weeks 14 and 23 was positive in three pregnant women (6 %), and between weeks 24 and 28, in four (8 %); there was no statistical difference in both measurements (p0.05). The sensitivity was 75 % (95 %, CI 30.1 % to 95.4 %), and the specificity 100.0 % (95 %, CI 92.3 % to 100 %).the O'Sullivan test performed between weeks 14 and 23 of gestation showed good sensitivity and specificity in the diagnosis of early gestational pregnancy.Objetivo: estimar la sensibilidad y la especificidad diagnóstica de la prueba de O'Sullivan para diabetes gestacional en el embarazo temprano. Metodología: se realizó estudio piloto que incluyó 50 mujeres con embarazo de bajo riesgo, sin alteración de glucosa. Se realizó la prueba de O'Sullivan para identificación de diabetes gestacional entre las semanas 14 y 23, y entre las semanas 24 y 28 para comparar resultados. Se administraron 50 g de glucosa, se cuantificó la glucemia a los 60 minutos y se consideró positiva si los valores eran = 140 mg/dL. Se calcularon sensibilidad, especificidad y valores predictivos. Resultados: la prueba de O'Sullivan entre las semanas 14 y 23 resultó positiva en tres de las gestantes (6 %), y la realizada entre las semanas 24 y 28 fue positiva en cuatro (8 %). No hubo diferencia estadística de la prueba entre ambas mediciones (p0.05). La sensibilidad fue de 75 % (IC 95 % de 30.1 % a 95.4 %), la especificidad de 100.0% (IC 95 % de 92.3 % a 100.0 %). Conclusiones: la prueba de O'Sullivan realizada entre las semanas 14 y 23 de gestación mostró buena sensibilidad y especificidad para identificar diabetes gestacional temprana.