Estrangulación/sofocación no fatal en el contexto de violencia de género: Aspectos médico-legales e implicancias para la práctica clínica / Non-fatal strangulation/suffocation in context of gender violence: Medicolegal aspects and implications in clinical practice

RESUMEN A pesar de los numerosos esfuerzos de la comunidad internacional en pos de erradicar todas las formas de violencia contra las mujeres, esta problemática se encuentra lejos de ser resuelta. Según la ONU, una de cada tres mujeres ha sufrido violencia física o sexual por parte de la pareja, violencia sexual fuera de la pareja, o de ambas, al menos una vez en su vida. El abordaje de esta problemática, en tanto necesidad social de salud de grupos poblacionales, permite una aproximación a la violencia de género como un problema de salud colectiva. En el plano de la violencia física, la estrangulación/sofocación ha sido identificada como una de las formas más letales de violencia doméstica y agresión sexual; se ha reportado que una víctima que es estrangulada una primera vez tiene 7,5 más probabilidades de ser asesinada posteriormente por el mismo abusador. Una víctima de estrangulación/sofocación puede perder la conciencia en segundos o morir en minutos, días o semanas después del ataque o sufrir daño cerebral permanente o invalidez, además del trauma emocional. Recientemente, se han generado cambios legales en la configuración de este delito; las penas han aumentado en el Reino Unido, Estados Unidos, Australia y Nueva Zelandia. El propósito de esta revisión de literatura de tipo narrativo, no sistemática, está orientada a presentar aspectos médico-legales actualizados de la estrangulación/sofocación no fatal en el contexto de la violencia de género, y se resaltan aquellas implicancias relevantes para la práctica clínica.

ABSTRACT Despite the numerous efforts of the international community to eradicate all forms of violence against women, this problem is far from being resolved. According to the UN, one in three women has suffered physical or sexual violence from an intimate partner, sexual violence outside the couple, or both at least once in their life. Addressing this problem as a social health need of population groups allows an approach to gender violence as a collective health problem. At the level of physical violence, strangulation/suffocation has been identified as one of the most lethal forms of domestic violence and sexual assault. Victims of domestic violence who have been choked or strangled are 7.5 times more likely to be killed by their partner. A victim of strangulation/suffocation can lose consciousness in seconds or die within minutes, days or weeks after the attack, as well as suffer permanent brain damage or disability or emotional trauma. Recently, legal changes have been generated in the configuration of this crime, the penalties have increased in United Kingdom, the United States, Australia and New Zealand. The current non-systematic narrative review of literature sought to explore updated medico-legal aspects of non-fatal strangulation/suffocation in the context of gender violence, and are highlightedrelevant implications for clinical practice.

Ventajas y desventajas de la modalidad virtual de enseñanza-aprendizaje percibidas en un curso de semiología en una facultad de medicina de Lima, Perú / Advantages and disadvantages of the virtual teaching modality perceived by the students in an introduction to clinical medicine course of a school of medicine in Lima, Peru

RESUMEN La pandemia de la Covid 19 forzó a las facultades de medicina a optar por una metodología virtual de enseñanza por la suspensión de las prácticas presenciales con pacientes reales en los establecimientos de salud, debido al confinamiento social y riesgo de contagio. Objetivo Determinar las ventajas y desventajas percibidas por los estudiantes de medicina en relación con la transición de las prácticas presenciales en hospitales a las sesiones virtuales de aprendizaje en un curso de semiología en una facultad de medicina de Lima, Perú. Material y métodos Estudio descriptivo de corte transversal realizado en estudiantes del 4to año de la carrera de Medicina. Los datos se recolectaron mediante una encuesta virtual no validada. Resultados 94 estudiantes respondieron la encuesta (tasa de respuesta: 51,1%). Las ventajas percibidas fueron: 57,4% tener mayor tiempo para estudio teórico y 38,3% en ahorro de tiempo en transporte y movilidad. Las desventajas fueron: 42,6% falta de contacto con pacientes reales y 39,4% no poder realizar una historia clínica adecuada. En cuanto al logro de objetivos de aprendizaje, el 72,3% consideró que logró identificar los problemas de salud del paciente, mientras que el 24,4% afirmó que logró realizar una adecuada historia clínica, y sólo el 9,6% que logró realizar un examen físico completo en pacientes. Conclusión La modalidad virtual de enseñanza permitió a los estudiantes tener más tiempo para revisar aspectos teóricos del curso, pero limitó la adquisición de habilidades prácticas, como realizar una anamnesis adecuada, presentar historias clínicas y examinar pacientes.

SUMMARY The COVID-19 pandemic forced the school of medicines to opt for a virtual teaching modality due to the suspension of face-to-face activities imposed by the lockdown. Objective To determine the advantages and disadvantages of the virtual teaching modality perceived by the students in an introduction to clinical medicine course of a school of medicine in Lima, Peru. Methods A virtual non-validated survey was circulated among fourth year medical students. Results 94 studentes answered the survey (51%). Perceived advantages were to have more time to study (57.4%) and saving time in transportation (39.4%). The disadvantages were lack of contact with real patients (42.6%) and not to be able to obtain a clinical history from patients (39.4%). The 72.3% of students were able to identify the medical problems of patients, but only 24.4% were able to obtain an adequate clinical history and just 9.6% performed an adequate physical examination. Conclusion The virtual teaching modality allowed the student to have more time for self-study but limited their abilities to obtain a clinical history and to perform a physical examination.

Implement quality control circle activities to improve customer satisfaction / 现代医院

Objective To study the application effect of quality control circle(QCC)in reducing the dissatisfaction rate of physical examination clients in health management center.Methods To establish QCC,selected the health check-up popula-tion in our hospital in September-2019 and March-2020,through the questionnaire investigation and analysis,compare the dis-satisfaction of the clients before and after the quality control circle.Results After carrying out QCC activities,the dissatisfaction of physical examination clients was significantly lower than that before QCC,and the difference was statistically significant(P＜0.05).Conclusion The activities of QCC in the health management center can effectively improve the quality of the physical examination work and reduce the dissatisfaction of the customers in the physical examination.It is of great significance to the health management.

Correlation between grip strength promotion and improvement of body composition and metabolic disorders in health examination population of different genders / 中华健康管理学杂志

Objective:To explore the correlation between grip strength promotion and improvement of body composition and metabolic disorders in health examination population of different genders.Methods:In this retrospective cohort study, clinical data of 600 people who received health examination and grip strength check-up two times or more in the Medical Examination Center of Peking University Third Hospital from January 2018 to November 2022 were selected. The general data, physical examination, biochemical parameters, body composition and grip strength results were collected. After the first physical examination, the grip strength test was conducted, appropriate resistance strength exercises were given based on individual evaluation results. A health lecture was held, and the information related to health exercise was pushed through WeChat official account every week. The grip strength test was completed at the same time at the second physical examination, and the difference between the two test results was calculated before and after the second physical examination. The generalized estimation equation was used to analyze the correlation between the improvement of grip strength and the improvement of body composition and metabolic disorders in different gender health-check population.Results:In man and women, the body mass index [(25.50±3.66) vs (25.33±3.74) kg/m 2, (22.41±3.55) vs (22.25±3.46) kg/m 2] and grip strength [(42.71±7.30) vs (41.77±7.36) kg, (25.28±5.30) vs (23.98±4.87) kg] at the second health check-up were all significantly higher than those at the first time, and the diastolic blood pressure [(72.79±10.30) vs (74.47±9.85) mmHg (1 mmHg=0.133 kPa), (66.93±8.90) vs (68.92±9.42) mmHg] and serum homocysteine [(17.96±14.09) vs (19.27±14.26) μmol/L, (9.47±3.91) vs (10.26±3.90) μmol/L] were all significantly lower than those at the first time (all P<0.05). Among man, the low-density lipoprotein cholesterol (LDL-C) at the second physical examination was significantly lower than that at the first time [(2.94±0.78) vs (3.00±0.69) mmol/L] (all P<0.05). Among women, the systolic blood pressure and uric acid at the second health check-up were both significantly lower than those at the first time [(109.34±12.85) vs (110.54±12.32) mmHg, (276.91±62.46) vs (287.16±68.78) μmol/L], and the waist-hip ratio was significant higher (85.8%±5.1% vs 85.4%±5.0%) (all P<0.05). In males, the decreased aspartate aminotransferase ( OR=0.932, 95% CI: 0.888-0.978) and the increased skeletal muscle index ( OR=75.370, 95% CI: 29.012-195.806) were both positively correlated with the elevation of grip strength (all P<0.05); and in females, the decreased homocysteine ( OR=0.876, 95% CI: 0.782-0.982) and glycosylated hemoglobin ( OR=0.423, 95% CI: 0.222-0.805) and increased skeletal muscle index ( OR=22.918, 95% CI: 11.114-47.256) were all positively correlated with the elevation of grip strength (all P<0.05). Conclusion:There is a positive correlation between the improvement of grip strength and the improvement trend of body composition and metabolic disorders in in health examination population of different genders.

Multiple correspondence analysis of the detection and risk factors of non-alcoholic fatty liver disease in middle-aged and young adult population undergoing physical examination / 中华健康管理学杂志

Objective:To analyze the detection of non-alcoholic fatty liver disease (NAFLD) and the multiple corresponding relationships of its risk factors in a middle-aged and young adult population undergoing health check-ups.Methods:This study was a cross-sectional study conducted on 15 423 individuals aged between 18 and 59 who underwent health check-ups at the Health Management Center of Henan Provincial Hospital of Traditional Chinese Medicine from January to December 2021. Relevant health examination data was collected, including basic information (age, gender, past medical history, smoking and alcohol consumption), physical examination, laboratory indicators such as blood lipids and blood glucose, and abdominal ultrasound results. The chi-square test was used to compare the prevalence of NAFLD among different characteristics of the population, and multiple correspondence analysis was employed for statistical analysis of related influencing factors.Results:A total of 5 859 cases of NAFLD were detected in this study, with a detection rate of 37.99%. The detection rate of NAFLD gradually increased with age ( χ2=828.841, P<0.001) and body mass index (BMI) ( χ2=1 889.809, P<0.001). The detection rates of NAFLD were higher in individuals with hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, low high-density lipoprotein cholesterolemia, high low-density lipoprotein cholesterolemia, and hyperuricemia compared to those without these conditions ( χ2 value was 1 223.673, 364.808, 444.074, 2 436.765, 1 323.736, 591.478, and 943.069, respectively, all P<0.001). Multiple correspondence analysis revealed that NAFLD was closely related to hypertension, hypertriglyceridemia, diabetes, hyperuricemia, overweight, obesity, and the age group of 45-49 years. Correspondence analysis graphs for males and females showed associations between NAFLD and hypertension, hypertriglyceridemia, hyperuricemia, overweight, and obesity. In males, NAFLD was closely related to the age group of 35-49 years, while in females, it was closely associated with the age group of 45-49 years and diabetes. Conclusions:The detection rate of non-alcoholic fatty liver disease is relatively high in middle-aged and young adult populations. Males, those who are overweight or obese, and individuals with hypertension, diabetes, hyperuricemia, or abnormal blood lipids are more susceptible to non-alcoholic fatty liver disease.

Current status of health management (physical examination) service capacity of medical institutions in Tianjin / 中华健康管理学杂志

Objective:To investigate and analyze the current status of health management (physical examination) service capabilities of medical institutions in Tianjin in 2021.Methods:It was a cross-sectional study. Using the census method, a questionnaire survey was conducted to obtain the health management (physical examination) service capabilities of 86 medical institutions in Tianjin in 2021. The questionnaire covered the basic information of the institution, human resources and equipment, physical examination items carried out, the annual number of people receiving physical examination, the degree of informatization, and the completion of quality control indicators. In this survey, a total of 86 questionnaires were distributed and 86 valid questionnaires were collected (100%). Mann-Whitney U test and χ2 test were used to compare the differences of health management (physical examination) indicators between public and private medical institutions, and to analyze the current health management (physical examination) service capabilities of medical institutions in Tianjin. Results:Among the 86 medical institutions included in the analysis, 53 (61.6%) were public institutions and 33 (38.4%) were private medical institutions. In terms of basic information, the proportion of comprehensive hospitals and level-3 medical institutions belonging to public institutions, as well as the time of health management (physical examination) business development, were significantly higher than those of private medical institutions [62.3% vs 30.3%, 62.3% vs 0, 11 (7, 5) years vs 7 (5, 10) years], and the proportion of independent setup of the physical examination center and the business area of health management (physical examination) were significantly lower than those of private institutions[33.3% vs 98.1%, 1 011 (600, 1 000) m 2 vs 2 000 (1 395, 2 782) m 2] (all P<0.05). In terms of practitioners, there were 2 964 health management (physical examination) practitioners in Tianjin in 2021, aged 43 (35, 56) years. The proportion of male practitioners, part-time practitioners, nurses, practitioners with intermediate professional title, chief inspection physician, health management specialist in public institutions and the time engaged in health management work of employees were all significantly higher than those in private medical institutions [20.6% vs 17.5%, 20.7% vs 8.1%, 33.8% vs 23.4%, 40.7% vs 27.3%, 7.1% vs 3.9%, 13.8% vs 4.7%, 6 (3, 11) years vs 5 (3, 8) years] (all P<0.05). In terms of business development, the implementation rates of preventive medical management, mental health management, hypertension risk management, health management contract service, pulmonary nodule management, health management intervention plan, health risk assessment, and health education programs in public institutions were significantly higher than those in private medical institutions (24.5% vs 0, 28.3% vs 0, 35.8% vs 15.2%, 39.6% vs 15.2%, 41.5% vs 12.1%, 50.9% vs 18.2%, 66.0% vs 36.4%, 83.0% vs 42.4%), and the annual health physical examination person-times, group and individual physical examination person-times in public institutions were significantly lower than those in private institutions [18 625 (11 844, 27 998) to 38 384 (10 832, 46 927), 14 818 (8 803, 23 915) to 28 663 (4 982, 41 927), 2 179 (1 221, 3 588) to 5 784 (1 461, 12 156)] (all P<0.05). Among the six quality control indicators of health examination, the completion rates of waist-hip circumference measurement in both types of institutions were low (<40%). Conclusion:Compared with public institutions, the talent echelon construction and service capability of health management (physical examination) in private medical institutions in Tianjin still needs to be improved.

Value of serum CEA, CA19-9 and CA72-4 detection in opportunistic screening for gastric cancer: a meta-analysis / 中华健康管理学杂志

Objective:To evaluate the application value of serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 and CA72-4 detection in the opportunistic screening (healthy physical examination) of gastric cancer based on a meta-analysis.Methods:A published literature searching up to May 2023 was performed in databases of CNKI, Wanfang Databases, VIP, PubMed, Cochran and Embase for studies on CEA, CA19-9 and CA72-4 detection and diagnosis of gastric cancer. The Quality Evaluation Tool of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the literature. Stata17.0 statistical software was used for meta-analysis.Results:According to the inclusion and exclusion criteria, a total of 23 studies with 5 287 gastric cancer patients and 6 129 controls were included. The pooled sensitivity and specificity of serum CEA, CA19-9 and CA72-4 as a diagnostic marker for gastric cancer were 0.42, 0.45 and 0.52, and 0.94, 0.91 and 0.95, respectively. The area under the summary receiver operating characteristic (sROC) curve for discriminating gastric cancer was 0.82, 0.77 and 0.87, respectively. The sensitivity of combined (parallel) diagnosis of gastric cancer with the three biomarkers increased to 0.66 (95% CI: 0.54-0.76), the specificity decreased to 0.85 (95% CI: 0.81-0.89), and the area under the curve basically remained unchanged at 0.86 (95% CI: 0.83-0.89). Conclusions:Due to poor sensitivity, the application effects of serum CEA, CA19-9 and CA72-4 as biomarkers for gastric cancer screening and physical examination are limited.

Hp infection rate, antibody typing and logistics regression analysis of 1111 physical examination people in plateau area / 公共卫生与预防医学

Objective To explore the Helicobacter pylori (Hp) infection rate and antibody typing of 1111 physical examination people in plateau area, and to analyze the risk factors of Hp infection by logistics regression analysis. Methods 1111 healthy people with physical examination in plateau area from January 2022 to December 2022 were selected as the research subjects. The Hp infection rate and antibody typing were calculated, and the risk factors of Hp infection were analyzed by logistics regression analysis. Results The Hp infection rate of physical examination people in plateau area was 62.47% (694/1 111). The infection rate of type I HP in infected patients was higher than that of type Ⅱ HP(75.50% vs 24.50%) (χ2=361.141, P2=4.418, 8.708, 16.565, 32.583, P=0.036, 0.003, 2=5.153, P=0.023). Often eating pickled or barbecued foods [OR (95%CI)=2.038 (1.049-3.961)], history of chronic gastric disease [OR(95%CI)=1.706 (1.132-2.569)] and family members living together≥4 [OR (95%CI)=1.857 (1.135-3.037)] were risk factors of Hp infection, and regular garlic consumption [OR (95%CI)=0.559 (0.346-0.903)] was a protective factor (P=0.036, 0.011, 0.014, 0.018). Conclusion The Hp infection rate and antibody Ure positive rate are higher in physical examination people in plateau area, and chronic gastric disease history and often eating pickled or barbecued foods are risk factors of Hp infection.

Physical examination for the detection of sexually transmitted infections among transgender women and travestis in Brazil: acceptability and associated factors / Realização do exame físico para detecção de infecções sexualmente transmissíveis entre mulheres trans e travestis no Brasil

ABSTRACT Objective This study aimed to determine the acceptability and factors associated with uptake of a physical examination for the detection of symptomatic sexually transmitted infections (STIs) by transgender women and travestis in Brazil. Methods: TransOdara was a multi-centric, cross-sectional STI prevalence study conducted among transgender women and travestis in five capital cities (Campo Grande, Manaus, Porto Alegre, Salvador and São Paulo) representing all Brazilian regions, between December 2019 and July 2021. A total of 1,317 self-identified transgender women and travestis aged ≥18 years were recruited using respondent-driven sampling and responded to a standard questionnaire. A medical consultation was offered including a physical examination and collection of samples from multiple sites to detect various STIs. Factors associated with uptake were investigated by reviewing demographic characteristics of participants who gave permission for physical examination (general, genital, and anorectal). Results: Most participants (65.4%, 95% confidence interval — 95%CI 62.7-68.0) gave permission for a general examination (including oropharyngeal), with fewer permitting genital (42.3%, 95%CI 39.6-46.0) or anorectal (42.1%, 95%CI 39.4-44.9) examinations. Overall, 34.4% (95%CI 31.8-37.0) of participants refused all examinations. Participants with STI symptoms were significantly more likely to give permission for full examination than asymptomatic participants (64.3 vs. 37.4%, adjusted odds ratio — AOR=3.6, 95%CI 2.4-5.5). Other factors significantly associated with uptake of a full examination in multivariate analysis included age (AOR=1.5 for ≥25 years), religion (AOR=1.7 for Afro-Brazilian, AOR=1.9 for other religions compared to no religion), and education (AOR=2.0 for higher-level). Conclusion: In the context of STI management, this study found limited acceptance of anogenital examinations among transgender women and travestis, with higher acceptance among those with STI symptoms.

RESUMO Objective Determinar a aceitabilidade e os fatores associados à realização do exame físico para detecção de infecções sexualmente transmissíveis (IST) sintomáticas em mulheres trans e travestis no Brasil. Métodos: Foram utilizados dados do "TransOdara", estudo transversal de prevalência de IST, realizado em cinco capitais brasileiras (Campo Grande, Manaus, Porto Alegre, Salvador e São Paulo) entre dezembro de 2019 e julho de 2021. As 1.317 mulheres trans e travestis, com idade ≥18 anos, recrutadas por meio do método respondent-driven sampling passaram por entrevistas e responderam a um questionário estruturado. Foi ofertada consulta médica, incluindo realização de exame físico e coleta de amostras de vários locais para detectar diversas IST. Para a análise dos fatores associados à aceitabilidade do exame físico (geral, genital e anorretal), considerou-se as características sociodemográficas das participantes que permitiram a sua realização. Resultados: A maioria (65,4%; intervalo de confiança - IC95% 62,7-68,0) concedeu permissão para o exame geral (incluindo orofaríngeo), com permissão concedida em menor proporção para os exames genitais (42,3%; IC95% 39,6-46,0) ou anorretais (42,1%; IC95% 39,4-44,9). No geral, 34,4% (IC95% 31,8-37,0) delas recusaram todos os exames. As participantes com sintomas de IST foram significativamente mais propensas a conceder permissão para o exame completo do que as participantes assintomáticas (64,3 vs 37,4%, odds ratio ajustado - AOR=3,6, IC95% 2,4-5,5). Os fatores significativamente associados à aceitabilidade do exame completo na análise multivariada incluíram idade (AOR=1,5 para ≥25 anos), religião (AOR=2,0 para afro-brasileiras, AOR=1,9 para outras religiões em comparação com nenhuma religião) e nível de escolaridade (AOR=2,0 para nível superior). Conclusão: No contexto do manejo de IST, nós observamos aceitação limitada de exames anogenitais entre mulheres trans e travestis, com maior aceitação entre aquelas com sintomas de IST.

Shortening of clavicle fractures: physical versus image examinations / Encurtamento de fraturas de clavícula: exame físico versus exame de imagem

ABSTRACT Objective: Determine the reliability of three different methods of evaluating bone shortening in displaced midshaft clavicle fractures (DCMF). Method: A cross-sectional analytical study evaluated bone shortening by metric tape (MT), radiography (X-ray), and computed tomography (CT). Twenty-six men had been evaluated and used clavícula not broken as control. The collection of data was of the blind type for three specialists. Differences and reliability were analyzed with the Friedman and Kappa tests and validated with the T-test (CI: 95%; significance index p<0.05; Software "R" version 3.2.2). Results: The MT measurements (control) showed abnormal distribution and significant statistical difference concerning the imaging tests (p=0.000008). There was a similarity between X-ray and CT and Kappa agreement of 0.65. The fractured clavicles presented similar measurements between the three methods (p=0.059), and the T-tests proved that the similarity was caused by chance or possible measurement errors. Conclusion: Measurement by metric tape showed a tendency to overestimate bone shortening. The CT showed more reliable results for the diagnosis; however, the X-ray was sufficient for decision-making by surgeons, and therefore, it is not possible to rule out the importance of this resource for DCMF. Level of Evidence IV; Case-Control Study.

RESUMO Objetivo: Determinar a confiabilidade de três diferentes métodos de avaliação do encurtamento ósseo em fraturas deslocadas do eixo médio da clavícula (FDEMC). Método: Estudo analítico transversal que avaliou o encurtamento ósseo por fita métrica (FM), radiografia (X-Ray) e tomografia computadorizada (TC). Foram avaliados 26 homens utilizando a clavícula não fraturada como controle. A coleta de dados foi do tipo cega por três especialistas. As diferenças e a confiabilidade foram analisadas com os testes de Friedman e Kappa e validados com o teste T (IC:95%; índice de significância p<0,05; Software "R" versão 3.2.2). Resultados: As medidas de FM (controle), apresentaram distribuição anormal e diferença estatísfica significativa em relação aos exames de imagem (p=0,000008). Houve semelhança entre radiografia e TC, concordância Kappa 0,65. As clavículas fraturadas apresentaram medidas semelhantes entre os três métodos (p=0,059) e os testes-T comprovaram que a semelhança foi provocada casualmente ou possíveis erros de medição. Conclusão: A medição por fita métrica apresentou tendência em superestimação do encurtamento ósseo. A TC apresentou resultados mais confiáveis para o diagnóstico, contudo, a radiografia foi suficiente para tomada de decisão dos cirurgiões e por isso, não é possível descartar a importância deste recurso para FDEMC. Nível de Evidência IV; Estudo Caso Controle.

Quality of Life After Diagnosis of Neurally Mediated Reflex Syncope by Tilt Test

Abstract Background: Vasovagal syncope (VVS) results in impaired quality of life (QoL). The response during the head-up tilt test (HUTT) influences QoL and recurrence. Objectives: To analyze the influence of the type of HUTT response on QoL in patients with VVS and recurrence of events after the exam. Methods: The SF-36 and Impact of Syncope on Quality of Life (ISQL) questionnaires were applied over 12 months after the HUTT. Unpaired Student's t test was used for differences between 2 groups of quantitative data with normal distribution. The recurrence of syncope episodes was analyzed using a Kaplan-Meier curve, and the log-rank test was applied to compare the curves regarding responses to the HUTT. Statistical significance was set at p value < 0.05. Results: We analyzed 82 patients (43.7 years old), 69% with previous recurrence (2.8 prior episodes). Cardioinhibitory response occurred in 46 patients; vasodepressor response occurred in 36, and 85.4% of patients received non-pharmacological treatment after the HUTT. During clinical follow-up, 43.9% had recurrence, mainly young patients (35.7 years; p = 0.002). On the SF-36, the best score was in functional capacity in men (p = 0.04) and patients without prior trauma (p = 0.001). There were lower limitations due to pain in patients without prior trauma (p = 0.003) and patients without prodromes (p = 0.009). On the ISQL, there were better mean scores in men (p = 0.002) and in patients without prior trauma (p = 0.02). Patients with cardioinhibitory response had better SF-36 and ISQL scores (p < 0.001). There was greater VVS recurrence in the cardioinhibitory response group (log-rank p = 0.011; hazard ratio: 8.48; 95% confidence interval: 7.59 to 9.3) from the second to the fourth month, with stabilization in the eighth month after the HUTT, when compared to patients with vasodepressor response. Conclusion: The majority of patients with VVS reproduced during the HUTT under non-pharmacological treatment did not report worsening of QoL during clinical follow-up. Worse QoL was observed in non-young patients and in patients with vasodepressor response, and it was not influenced by recurrence after the HUTT.

Uso de la ultrasonografía en la evaluación de la retención urinaria en pacientes críticos / Use of ultrasonography in the evaluation of urinary retention in critically ill patients / Utilização da ultrassonografia na avaliação de retenção urinária em pacientes críticos

Objetivo: medir el volumen urinario por medio de la ecografía vesical, realizado por una enfermera en pacientes críticos, después de la retirada de la sonda urinaria permanente y verificar los factores relacionados en la retención urinaria. Método: estudio cuantitativo, observacional y transversal, realizado con 37 pacientes críticos de ambos sexos, mayores de 18 años, con retiro de catéter vesical permanente en las últimas 48 horas. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Los datos fueron presentados a través de distribución de frecuencias, medidas de centralidad y variabilidad, asociación mediante la prueba exacta de Fisher y, para el análisis, regresión logística binomial múltiple. Resultados: de los 37 pacientes, en su mayoría fue de sexo masculino, con una edad média de 54,9 años. La medición del volumen urinario por ecografía osciló entre 332,3 y 950 ml, y el 40,54% de los pacientes presentó retención urinaria. La retención urinaria se asoció significativamente a la aparición de infección urinaria, estreñimiento intestinal y diuresis por rebosamiento espontáneo. Los pacientes con infección del tracto urinario tenían 7,4 veces más probabilidades de tener retención urinaria. Conclusión: la ecografía vesical fue eficaz para medir el volumen urinario después de retirar el catéter urinario permanente y puede contribuir a la detección de retención urinaria.

Objective: to measure urinary volume through bladder ultrasound, performed by a nurse in critically ill patients, after removal of the indwelling urinary catheter and to verify the related factors on urinary retention. Method: quantitative, observational and cross-sectional study, carried out with 37 critically ill patients of both sexes, over 18 years of age, with removal of indwelling urinary catheter in the last 48 hours. A questionnaire containing sociodemographic and clinical variables and an ultrasound examination were used. Data were presented through frequency distribution, centrality and variability measures, association using Fisher`s exact test and, for analysis multiple binomial logistic regression analysis. Results: the 37 patients were mostly male, with a mean age of 54.9 years. The measurement of urinary volume by ultrasound ranged from 332.3 to 950 ml, and 40.54% of patients had urinary retention. Urinary retention was significantly associated with the occurrence of urinary tract infection, intestinal constipation and spontaneous overflow diuresis. Patients with urinary tract infection were 7.4 times more likely to have urinary retention. Conclusion: bladder ultrasonography was effective in measuring urinary volume after removal of the indwelling urinary catheter and and may contribute to the detection of urinary retention.

Objetivo: mensurar o volume urinário por meio da ultrassonografia de bexiga, realizada por enfermeiro em pacientes críticos, após a remoção do cateter vesical de demora, e verificar os fatores relacionados na retenção urinária. Método: estudo quantitativo, observacional e transversal, realizado com 37 pacientes críticos de ambos os sexos, idade superior a 18 anos, com retirada de cateter vesical de demora nas últimas 48 horas. Foram utilizados um questionário contendo as variáveis sociodemográficas e clinicas e o exame de ultrassonografia. Os dados foram apresentados por meio da distribuição de frequência, medidas de centralidade e de variabilidade, associação pelo teste exato de Fisher e, para análise a regressão logística binomial múltipla. Resultados: dos 37 pacientes, a maioria era do sexo masculino, com média de idade de 54,9 anos. A mensuração do volume urinário pela ultrassonografia variou de 332,3 a 950 ml, sendo que 40,54% dos pacientes apresentaram retenção urinária. A retenção urinaria apresentou associação significativa para a ocorrência de infecção do trato urinário, constipação intestinal e diurese espontânea por transbordamento. Pacientes com infecção urinária tiveram 7,4 vezes mais chance de apresentar retenção urinária. Conclusão: ultrassonografia de bexiga foi eficaz para mensurar o volume urinário após a remoção do cateter vesical de demora e poderá contribuir na detecção da retenção urinária.

Multimedia educativa: Examen Físico del Aparato Cardiovascular

Introducción: La formación de estudiantes de las Ciencias Médicas se inició como algo netamente presencial; al pasar el tiempo las invenciones fueron formando parte de la práctica médica y educativa, donde la educación digital tomó un puesto relevante. Objetivo: Diseñar un software educativo para la enseñanza y aprendizaje de las características del examen físico del aparato cardiovascular. Métodos: Se realizó un estudio de innovación y desarrollo tecnológico con el diseño de una multimedia, usando la plataforma Chreasoft, para el estudio del examen físico del aparato cardiovascular en la Filial de Ciencias Médicas Nuevitas durante el curso 2020 - 2021. El universo de aplicación del software se conformó por los 33 estudiantes de 3er. año de la carrera de medicina. Resultados: Durante el diagnóstico inicial, tres estudiantes resultaron evaluados de mal. En la evaluación final, luego de utilizar el software, predominó el uso de bibliografía digital e impresa; además se evidenció un incremento en el nivel de información de los estudiantes, ya que la mayoría obtuvo calificación de bien; se destacó el nivel de satisfacción en la categoría de alto tras el uso del software educativo por los estudiantes. Conclusiones: La multimedia Examen Físico del Aparato Cardiovascular constituye, en nuestro medio, un aporte al proceso de enseñanza aprendizaje y tributa al modo de actuación del futuro egresado, mediante la formación de valores, interactividad con el contenido, retroalimentación, evaluación y el desarrollo de habilidades, como el trabajo independiente y la autopreparación.

Introduction: The training of medical sciences students began as something involving purely face-to-face activities; but as time passed, the inventions became part of the medical and educational practice where digital education reached a relevant position. Objective: To design an educational software for the teaching and learning of the characteristics of the physical examination of the cardiovascular system. Methods: A study of innovation and technological development was carried out with the design of a multimedia, using the Chreasoft platform for the study of the physical examination of the cardiovascular system at the Subsidiary of Medical Sciences Nuevitas during the 2020 - 2021 academic year. The universe of application of the software was made up of the 33 students in the 3rd year of medical studies. Results: During the initial diagnosis, three students were evaluated as poor. In the final evaluation, after using the software, the use of digital and printed bibliography predominated. In addition, an increase in the level of information among students was evidenced since most of them were evaluated as good; after the use of the educational software the high level of satisfaction expressed by the students was highlighted. Conclusions: The multimedia Physical Examination of the Cardiovascular System constitutes, in our field, a contribution to the teaching-learning process and contributes to the way of acting of the future graduate through the formation of values, interactivity with the content, feedback, evaluation and development of skills, independent work, and self-preparation.

Exame físico em ginecologia / Physical examination in gynecology

O exame físico na prática ginecológica diuturna é o sustentáculo de uma perspectiva diagnóstica com vistas a uma abordagem individualizada, oportuna e humanizada da paciente. Lança mão de técnica semiótica clássica, inicialmente, após avaliação de sinais vitais, minuciosa inspeção ectoscópica, seguida de exame físico especial. E deverá ser realizado em ambiente adequadíssimo, sem nenhuma improvisação e ou adaptações não compatíveis, com a importância e a segurança garantidas por um exame físico de boa qualidade. O exame físico de mamas tem como objetivo primordial a identificação de nódulos mamários e, eventualmente, de tumores localmente avançados; e relativa tranquilidade é assegurada às pacientes quando ele é considerado normal. O exame físico vulvar permite a identificação de prolapso de órgãos pélvicos, neoplasia intraepitelial e/ou invasiva vulvar e distúrbios de desenvolvimento sexual, além de oferecer subsídios para a propedêutica da vulvodínea, sendo, principalmente, uma oportunidade para o diagnóstico em dermatologia vulvar, mesmo a vulva correspondendo a apenas 1% da pele feminina. O exame especular, um clássico da ginecologia, é indispensável para a triagem do câncer de colo uterino. Por fim, o toque genital, a despeito de sua subjetividade, permite a avaliação dos órgãos genitais internos.

Physical examination in daytime gynecological practice is the mainstay of a diagnostic perspective with a view to an individualized, timely and humanized approach to the patient; resorting to the classical semiotic technique, initially, after assessing vital signs, a thorough ectoscopic inspection, followed by a special physical examination; which should be carried out in a very suitable environment, without any improvisation or adaptations that are not compatible with the importance and safety guaranteed by a good quality physical examination. The primary objective of the physical examination of the breasts is to identify breast nodules and possibly locally advanced tumors; in addition to relative tranquility, assured to patients, when the respective exam is considered normal. Vulvar physical examination allows the identification of pelvic organ prolapse; vulvar intraepithelial and/or invasive neoplasia; sexual development disorders; in addition to offering subsidies for the propaedeutics of vulvodynia; and, above all, it is an opportunity for diagnosis in vulvar dermatology, even though the vulva accounts for only 1% of female skin. Specular examination, a classic in gynecology, is essential for screening for cervical cancer. Finally, the genital touch which, despite its subjectivity, allows the evaluation of the internal genital organs.

Síndrome de niño agredido: reporte de caso / Battered child síndrome: case report

La valoración médico legal en los casos de Síndrome de niño agredido debe ser minuciosa, y abarcar todos los aspectos que indican los artículos y guías nacionales e internacionales, para tener una certeza diagnóstica, debe incluir una historia médico legal completa, examen físico detallado y estudios complementarios, así como diagnóstico diferencial. El presente artículo abarca algunos de los aspectos principales a tomar en cuenta ante la sospecha de abuso infantil, mediante la presentación y abordaje de un caso clínico.

The medical legal assessment in the cases of Attacked Child Syndrome must be thorough and cover all the aspects indicated in the articles and national and international guides, to have a diagnostic certainty, it must include a complete legal medical history, detailed physical examination and complementary studies, as well as differential diagnosis. This article covers some of the main aspects to consider when suspected of child abuse, through the presentation and approach of a clinical case.

Factors affecting physical examinations among patients with severe mental disorders in Shaoxing City / 预防医学

Objective@#To investigate the proportion of physical examinations among patients with severe mental disorders and its influencing factors in Shaoxing City, Zhejiang Province, so as to provide the evidence for improving the proportion of physical examinations among patients with severe mental disorders. @*Methods @#The epidemiological and clinical features of patients with severe mental disorders included in community management in Shaoxing City in 2022 were collected from Zhejiang Provincial Severe Mental Disorder Management Information System, including demographics, disease diagnosis and treatment, physical examination, and rescue and assistance. Factors affecting the physical examination were identified among patients with severe mental disorders using a multivariable logistic regression model. @*Results@#A total of 25 468 patients with severe mental disorders were enrolled in Shaoxing City in 2022, including 12 151 males and 13 317 females, with a male to female ratio of 0.91∶1, and the participants had a mean age of (54.34±14.71) years. Schizophrenia was the predominant type of severe mental disorders (15 419 cases, 60.54%), and 21 374 subjects participating in the physical examinations in 2022 (83.92%). Multivariable logistic regression analysis showed that female (OR=0.901, 95%CI: 0.832-0.975), urban areas (OR=0.506, 95%CI: 0.468-0.547), mental disorders due to epilepsy (OR=1.779, 95%CI: 1.104-2.866), hospitalized treatment (6 to 10 times, OR=0.523, 95%CI: 0.401-0.681; 11 times and more, OR=0.177, 95%CI: 0.108-0.288), special diseases in outpatient (OR=1.738, 95%CI: 1.597-1.891), receiving medical assistance (OR=2.851, 95%CI: 2.616-3.107), targets of the community care and assistance groups (OR=1.653, 95%CI: 1.471-1.857) and guardian (spouse, OR=1.777, 95%CI: 1.513-2.086; children, OR=1.277, 95%CI: 1.069-1.526; parents, OR=1.342, 95%CI: 1.143-1.576) were statistically associated with the proportion of physical examinations. @*Conclusions@#The proportion of health examinations was 83.92% among patients with severe mental disorders in Shaoxing City in 2022. Gender, residence, guardian, disease diagnosis, times of hospitalized treatment, medical assistance, special diseases in outpatients and target of community care and assistance groups were factors affecting health examinations among patients with severe mental disorders.

Construction and reliability and validity test of knowledge, attitude and practice questionnaire on Helicobacter pylori infection in physical examination population / 中国实用护理杂志

Objective:To develop a questionnaire on knowledge, attitude and practice of Helicobacter pylori (Hp) infection among physical examination population, and to verify its reliability and validity.Methods:This study was a cross-sectional survey. Based on the theory of knowledge, attitude and practice, the first draft of the questionnaire on knowledge, attitude and practice of Hp infection in physical examination population was designed by means of retrospective literature research, qualitative interview, discussion in the research group. The structure and items of the questionnaire were consulted and revised by the expert consultation method (Delphi method). Through pre investigation of 186 physical examination personnel from May to June in 2021, the final version of the "knowledge, attitude and practice questionnaire on Helicobacter pylori infection among physical examination population" was formed after adjustment and verification of the reliability and validity of the questionnaire.Results:The questionnaire of knowledge, attitude and practice of Hp infection in physical examination population included 3 dimensions and 28 items, and the cumulative variance contribution rate was 56.271%. The content validity index of each item level of the questionnaire was 0.75-1.00, and the content validity index of the total questionnaire was 0.94. The Cronbach alpha of knowledge, attitude and practice dimensions in this questionnaire were 0.862, 0.901 and 0.798 respectively. The overall Cronbach alpha of the questionnaire was 0.890, and the half reliability was 0.698. The test-retest reliability of the questionnaire was 0.919, and the test-retest reliability of each dimension was 0.924, 0.917 and 0.845.Conclusions:The questionnaire has good reliability and validity, and can be used to measure the level of knowledge, attitude and practice of Hp infection in physical examination population.

Status and progress of school screening for adolescent scoliosis / 中华骨科杂志

Scoliosis is one of the common diseases in adolescents. It can rapidly progress during the peak growth period. Scoliosis school screening (SSS) is the main way for early detection and treatment of this disease. The SSS project began in the 1960s and was gradually promoted from the United States to the world. However, some problems were gradually exposed during the implementation of the project, such as the high false positive rate of screening methods, potential radiation damage, the uncertainty of the potency ratio of screening and the lack of evidence-based medical evidence of the effectiveness of high-level conservative treatment, which led to many European and American countries stopping the implementation of SSS. However, with the progress of research related to diagnosis and treatment of scoliosis, based on the latest evidence-based medical evidence assessment, the United States Preventive Medicine Task Force again adjusted the recommendation level of SSS to "no recommendation, no objection" in 2018. In recent years, SSS has gradually received extensive attention from the Chinese government and society. Five national ministries and commissions also issued a document in 2021 to include scoliosis in the monitoring of common diseases among students. However, the implementation of the project should also refer to the effectiveness criteria of disease screening recommended by the World Health Organization. In the future, with the improvement of the accuracy of scoliosis screening methods, the development of multi-mode screening such as artificial intelligence, the emergence of non-radiation detection technology and the improvement of the effectiveness of conservative treatment of mild and moderate scoliosis, the long-term and large-scale implementation of SSS project and the early prevention and control of scoliosis will be possible to truly achieve.

Development trend of physical examination volume and revenue in health-checkup institutions in China from 2010 to 2019 / 中华健康管理学杂志

Objective:To investigate the development trend of physical examination volume and revenue in health-checkup institutions in China from 2010 to 2019.Methods:In this longitudinal study, the annual income, annual physical examination volume and other indicators reflecting institutional size were collected with questionnaire from 374 health-checkup institutions in the year of 2010, 2015 and 2019. The geometric mean method is used to calculate the compound annual growth rate (CAGR) of the annual physical examination volume, annual income, mean per capita cost from 2010 to 2015 and 2015 to 2019.Results:The annual physical examination volume of health-checkup institutions increased from 1.81 (1.00, 3.20) ×10 4 person times in 2010 to 5.08(3.50, 7.28)×10 4 person times in 2019; the CAGR of the physical examination volume from 2010 to 2015 was 14.04%(8.14%, 23.78%), and it was 9.49%(3.39%, 19.07%) from 2015 to 2019. The annual revenue increased from 768.73 (350.00, 1 623.75) ×10 4 yuan in 2010 to 3 500.00 (1 997.73, 6 818.54) ×10 4 yuan in 2019; the CAGR of annual revenue from 2010 to 2015 was 25.75% (15.17%, 35.09%), and it was 15.67% (8.78%, 26.11%) from 2015 to 2019. The mean per capita cost increased from 434.26 (278.82, 666.66) yuan in 2010 to 755.80 (506.90, 1 005.42) yuan in 2019; the CAGR of the mean per capita cost was 9.82% (1.71%, 17.10%) from 2010 to 2015, and it was 5.37% (0.95%, 10.46%) from 2015 to 2019. Conclusion:From 2010 to 2019, health-checkup institutions in China developed rapidly, and the CAGR of the annual physical examination volume, annual revenue, mean per capita cost are high.

Current situation of health checkup and the management willingness of post-test abnormal values among residents of mega communities / 中华健康管理学杂志

Objective:To investigate the current status of health checkups and the management willingness of post-test abnormal values in residents of mega communities, and to explore the factors affecting the demand for health management of abnormal values after examination.Methods:A cross-sectional study. The residents of Huaguoyuan Community in Guiyang City were enrolled as the objects of this surveywith stratified systematic sampling method and questionnaire survey. The binary logistic regression was used to analyze the influencing factors of health management demand for abnormal values after examination.Results:There were 404 residents participating in this survey, and 182 cases were male (45.05%) and 222 cases were female (54.95%); the mean age was (39.64±15.03) years. There were 179 (44.31%) urban residents and 225 (55.69%) rural residents. There were 162 (40.10%) floating population and 242 (59.90%) non-floating population. Of the residents, 34.2% participated in the physical examination independently due to physical reasons. The age ( χ 2=16.227), household registration ( χ 2=16.117) and occupation ( χ 2=36.454) had statistically significant differences in residents′ participation in physical examination; the household registration ( χ 2=18.726, P<0.001) and occupation ( χ 2=18.094, P=0.034) had significant differences in the handling methods of abnormal values of physical examination. The age ( OR=7.00, P=0.032) and income ( OR=0.33, P=0.047) were the influencing factors of health management needs of abnormal values after health checkup. Conclusion:The awareness of active physical examination of residents in mega community is weak, and it is recommended to strengthen health education and health promotion; residents have a high willingness to the management of abnormal values after health checkup, it can be an important supplement to improve the service quality of physical examination related institutions.