Adherencias del capuchón del clítoris al glande: una condición poco estudiada y poco examinada / Clitoral hood adhesions to the glans penis: an understudied and under-examined condition

INTRODUCCIÓN: El clítoris es una de las estructuras vulvares menos examinadas, pese a su relevancia en la vida sexual y sus importantes relaciones anatómicas. Las adherencias del capuchón del clítoris han sido descritas y clasificadas según la exposición del glande, siendo relacionadas con trastornos del deseo sexual. La inervación del clítoris depende de raíces de S3-S4, siendo posible que síntomas frecuentes del piso pélvico tengan relación con esta condición. Realizamos un análisis retrospectivo de pacientes de policlínico de piso pélvico entre noviembre de 2021 y abril de 2022. Se incluyeron 100 pacientes con adherencias al ingreso. RESULTADOS: Promedio de edad 45,8 ± 15,5 años. Las adherencias fueron el 19% leves, el 62% moderadas y el 18% graves. Los principales síntomas eran mal vaciado vesical (38%), dolor (28%), disfunción sexual (39%) y síntomas irritativos vesicales (43%); solo una paciente fue asintomática. El área visible promedio del clítoris era de 20,7 ± 13,7 mm2. CONCLUSIONES: Las adherencias del capuchón del clítoris son un hallazgo común, muchas veces no diagnosticadas, por lo que su evaluación debe ser parte de la exploración física. Pueden asociarse a sintomatología de piso pélvico.

INTRODUCTION: The clitoris is one of the least examined vulvar structures despite its relevance in sexual life and important anatomical relationships. Clitoral hood adhesions have been described in the literature, classified based on glans exposure, and related to sexual desire disorders. The innervation of the clitoris depends on the roots of S3-S4, and frequent pelvic floor symptoms may be associated with this condition. We retrospectively analyzed the clinical record of patients admitted to a pelvic floor clinic between November 2021 and April 2022. One hundred patients with adhesions at the time of admission were registered. RESULTS: Average 45.8 ± 15.5 years. Clitoral hood adhesions were mild (19%), moderated (62%), or severe (18%). The main symptoms were voiding dysfunction symptoms (38%), pain (28%), sexual dysfunction (39%), and irritative bladder symptoms (43%); only one patient was asymptomatic. The visible area of the clitoris was 20.7 ± 13.7 mm2. CONCLUSIONS: Adhesions of the clitoral hood are often undiagnosed, and its analysis should be part of the physical exam. Clitoral hood adhesions could be associated with pelvic floor symptoms.

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.

Avalia TIS SPF: protótipo de software para avaliação clínica de enfermeiros em penitenciária federal de segurança máxima / Evaluates TIS SPF: software prototype for clinical assessment of nurses in maximum security federal penitentiary

Resumo: Objetivou-se desenvolver o protótipo de um software para avaliação clínica de enfermeiros, no serviço de saúde da penitenciária federal de segurança máxima de Porto Velho, Brasil. Como método, seguiram-se os moldes da pesquisa metodológica de produção tecnológica, que teve como cenário uma penitenciária federal, e foi desenvolvida em duas fases: fase 1, denominada fase exploratória, que incluiu três etapas: a) revisão de literatura; b) informações obtidas dos participantes sobre o conhecimento da avaliação clínica; c) análise dos dados; fase 2, denominada de fase de desenvolvimento do modelo de prototipação, o qual seguiu o ciclo de vida de desenvolvimento de sistema, dividido em três etapas: análise e especificação; desenvolvimento; e manutenção, propostas por Pressman (2011). Como produto, obteve-se o protótipo do software intitulado AVALIA TIS - SPF, com características dinâmicas que inclui módulos de cadastro e login do usuário; identificação do paciente; histórico/anamnese e avaliação clínica. Conclui-se que esta ferramenta tem potencial para instrumentalizar o enfermeiro na execução e documentação da primeira etapa do processo de enfermagem, contribuindo na valorização e sustentação da prática profissional, colaborando para a assistência integral da população carcerária. É viável a replicabilidade para outras unidades prisionais, temas e outras áreas do conhecimento. Tem potencial para impacto social, mantendo a população de pessoas privadas de liberdade, com melhor qualidade de vida durante o período do cumprimento de pena; impacto econômico, com possibilidade de identificação precoce de problemas de saúde e, consequentemente, menor número de complicações que exigem utilização de serviços de saúde de atenção secundária ou terciária. O teor inovador encontra-se no fato de implementar um sistema de informação segura dos dados dos custodiados, com possibilidade de ampliação de todas as penitenciárias de segurança máxima brasileiras.

Abstract: This study aimed to develop a software prototype to clinically evaluate nurses in the health service of the maximum-security federal penitentiary in Porto Velho. We followed the methodological research of technological production using a federal penitentiary as a scenario. The study consisted of two phases: Phase 1, the exploratory phase, which included three stages: a) literature review; b) the information obtained from participants regarding their knowledge of clinical evaluation; and c) data analysis; Phase 2, the prototyping model development phase, which followed the system development life cycle, divided into three stages: a) analysis and specification; b) development; and maintenance, proposed by Pressman (2011). The final product is a software prototype entitled AVALIA TIS - SPF, with dynamic characteristics that include user registration and login modules, patient identification, history/anamnesis, and clinical evaluation. In conclusion, this tool has the potential to equip nurses in the execution and documentation of the first stage of the nursing process, contributing to the appreciation and support of professional practice and collaborating for the integral assistance of the prison population. Replicability for other prison units, themes, and other areas of knowledge is feasible. It has the potential for social impact, giving a better quality of life to the freedom-deprived population while serving their sentence, and economic impact, with the possibility of early identification of health problems and, consequently, fewer complications that require secondary or tertiary health care services. The innovative content is because it implements a secure information system for the data of those in custody, with the possibility of expanding all Brazilian maximum security penitentiaries.

Tratamiento psicológico inclusivo como modalidad terapéutica en el estado cognitivo-emocional-conductual en las personas prejubilables / Inclusive psychological treatment as a therapeutic modality for cognitive, emotional and behavioural state in pre-retired people

Introducción: La prejubilación se define como una etapa de la vida donde convergen factores biológicos, psicológicos, sociales, culturales, espirituales y ambientales que preparan al individuo para un cambio global y profundo. Objetivo: Precisar mediante el tratamiento psicológico inclusivo los cambios ocurridos en el proceso cognoscitivo del pensamiento y las modificaciones obtenidas en la esfera emocional en el grupo intervenido. Métodos: Se realizó un estudio cuasi-experimental en el Policlínico Docente «Marta Abreu», de Santa Clara, Villa Clara, en el período de enero de 2017 a febrero de 2019. Se emplearon procedimientos, métodos y técnicas con la aplicación de esta modalidad terapéutica en un grupo estudio de 200 personas prejubilables, de 55 a 65 años de edad. Se utilizaron métodos teóricos, empíricos y estadísticos-matemáticos. Se aplicaron técnicas psicológicas antes del tratamiento psicológico inclusivo, y después de este, en el grupo estudio y en el grupo control. Resultados: Fueron muy reveladores en el grupo estudio, y se registraron cambios muy significativos en los procesos intelectuales, en el pensamiento lógico verbal, práctico constructivo y rumiativo; además estados emocionales ansioso bajo y depresivo leve, autoestima alta, y notable mejoría en la vulnerabilidad al estrés. En el grupo control no se reflejaron cambios favorables. Conclusiones: El tratamiento psicológico inclusivo resultó efectivo por el logro de cambios positivos en el estado cognitivo-emocional-conductual en personas prejubilables del grupo estudio. La aplicación de las estrategias de desactivación fisiológica, cognitivas, reflexivo vivenciales, informativas, así como las habilidades de conductas de afrontamiento, las acciones de mantenimiento y generalización y las ayudas paliativas y moderadoras de estrés en la atención a personas prejubilables, constituyó un novedoso recurso terapéutico.

Introduction: pre-retirement is defined as a stage of life where biological, psychological, social, cultural, spiritual and environmental factors converge to prepare the individual for a global and profound change. Objective: to determine, through the inclusive psychological treatment, the changes occurred in the cognitive process of thinking and the modifications obtained in the emotional sphere in the intervened group. Methods: a quasi-experimental study was carried out at "Marta Abreu" Teaching Polyclinic in Santa Clara, Villa Clara from January 2017 to February 2019. Procedures, methods and techniques were used with the application of this therapeutic modality in a study group of 200 pre-retired people aged 55 to 65 years old. Theoretical, empirical, statistical and mathematical methods were used. Psychological techniques were applied before and after the inclusive psychological treatment in the study and control groups. Results: they very revealing in the study group, and very significant changes were registered in intellectual processes as well as in verbal-logical, practical-constructive and ruminative thinking; also low anxious and mild depressive emotional states, high self-esteem, and notable improvement in vulnerability to stress. No favorable changes were reflected in the control group. Conclusions: the inclusive psychological treatment was effective in achieving positive changes in the cognitive, emotional and behavioural state in pre-retired people from the study group. The application of physiological deactivation, cognitive, experiential, reflective, and informative strategies, as well as coping behavioural skills, maintenance and generalization actions and palliative and moderating stress aids in the care of pre-retired people constituted a novel therapeutic resource.

Computer-based clinical examination (CCE) in surgery: would It complement or replace the OSCE in the post-COVID-19 era?

Objectives: Surgical clinical assessment of medical students is confronted by many challenges particularly the increasing numbers of students with limited resources, and pandemics. The search for new tools of assessment continues. Our objectives were: (1) To develop a computer-based clinical exam (CCE) and identify its characteristics (2) To assess its acceptability of the students. Method: The study was conducted at the Surgical Department, Alzaiem Alazhari University (AAU) between February and August, 2017. We used the modular object oriented dynamic learning environment (MOODLE) program as a platform to upload and deliver the exam. The exam consisted of 45 questions (stations). Each consisted of a clinical scenario accompanied by a photograph (of a patient or investigation) or short video followed by multiple choice questions (MCQs). A questionnaire was designed to get the students' feedback. We analyzed the questionnaire and scores obtained by the students and compared them to their performance in other tools of the surgical exam, using SPSS statistical program. Results: The study included 188 final year medical students. There was a highly significant correlation of the CCE scores of each student with their final result (r= 0.67), and with other tools of the surgery exam particularly the objective structured clinical examination (OSCE). Students' acceptability was high. Conclusion: The CCE is valid and practicable. It saves time and is popular with the students and tutors. It complements the OSCE in the assessment of clinical competency and allows wide coverage of the curriculum. It is expected to gain importance and popularity in the post-COVID-19 era.

Calidad de la prueba parcial de un curso propio sobre diátesis hemorrágicas en la carrera Estomatología

Introducción: Dentro de los grandes desafíos que la formación universitaria en el sector salud enfrenta hoy, está el implementar y validar instrumentos de evaluación efectivos. Objetivo: Evaluar la calidad de la prueba parcial del curso propio Bases morfofuncionales de las principales diátesis hemorrágicas en Estomatología, de la Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, curso 2022. Método: Estudio observacional analítico y transversal, en 30 exámenes correspondientes a la prueba parcial del curso propio Bases morfofuncionales de las principales diátesis hemorrágicas en Estomatología, plan de estudio E, carrera de Estomatología, Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, curso 2022. Se analizó la correspondencia del fondo de tiempo y la cantidad de ítems explorados en el examen, se calcularon índices de dificultad y de discriminación de incisos y preguntas, coeficiente de discriminación biserial puntual y de consistencia interna. Resultados: Existió correspondencia adecuada entre el fondo de tiempo asignado a los contenidos de las temáticas y la cantidad de ítems explorados en el examen. Predominaron los reactivos con índice de dificultad media y buen poder de discriminación. La consistencia interna de las preguntas de modo individual fue excelente, pero la del examen en general fue baja. Conclusiones: La calidad del examen parcial del curso propio Bases morfofuncionales de las principales diátesis hemorrágicas en Estomatología, aplicado en la Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, curso 2022, fue poco adecuada.

Introduction: One of the challenges facing universities of health sciences today is the implementation and validation of effective tools for evaluation. Objective: To evaluate the quality of the partial exams of an in-house course in Morphofunctional bases of the most common hemorrhagic diathesis in Stomatology, Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, course 2022. Method: An analytical and transversal observational study was carried out. For the study, it was selected 30 of the partial exams implemented in the in-house Morphofunctional bases of the most common hemorrhagic diathesis in Stomatology course, type (E) course syllabus, Stomatology career, Facultad de Estomatología, Universidad de Ciencias Médicas de Santiago de Cuba, course 2022. Correspondence between scheduled time and the number of items used in the test was assessed, and also, difficulty index and discrimination index for items and questions, point-biserial item discrimination coefficient and internal consistency coefficient were calculated. Results: There was an adequate correspondence between the time scheduled for the topics and the number of items used in the exam. Items with a moderate difficulty index and high degree of discrimination index predominated. The internal consistency of the individual questions was excellent, but the exam in general was low. Conclusions: The quality of the partial exam of the in-house course Morphofunctional bases of the main hemorrhagic diathesis treated in Stomatology, giving in the Faculty of Stomatology, University of Medical Sciences of Santiago de Cuba, course 2022, was inadequate.

Introdução: Entre os grandes desafios que a educação universitária na área da saúde enfrenta hoje, está a implementação e validação de instrumentos de avaliação eficazes. Objetivo: Avaliar a qualidade do teste parcial do curso Bases morfofuncionais da diátese hemorrágica principal em Estomatologia, da Facultad de Estomatología de la Universidad de Ciencias Médicas de Santiago de Cuba, curso 2022. Método: Estudo observacional analítico e transversal, em 30 exames correspondentes à prova parcial do próprio curso Bases morfofuncionais da diátese hemorrágica principal em Estomatologia, plano de estudos E, carreira de Estomatologia de la Universidad de Ciencias Médicas de Santiago de Cuba, curso 2022. A correspondência do analisou-se o fundo de tempo e o número de itens explorados no exame, calcularam-se índices de dificuldade e discriminação de subseções e questões, coeficiente de discriminação bisserial pontual e consistência interna. Resultados: Houve correspondência adequada entre o tempo destinado aos conteúdos dos temas e o número de itens explorados no exame. Predominaram os itens com índice de dificuldade médio e bom poder de discriminação. A consistência interna das questões individuais foi excelente, mas a do exame como um todo foi baixa. Conclusões: A qualidade do exame parcial das Bases Morfofuncionais da diátese hemorrágica principal do curso de Estomatologia, aplicado na Facultad de Estomatología de la Universidad de Ciencias Médicas de Santiago de Cuba, curso 2022, não foi adequada.

Instrumento en Excel para la calificación de exámenes de la educación médica en Cuba / Instrument in Excel for the Qualification of Exams in the Cuban Medical Education

Introducción: La evaluación de un examen de varias preguntas genera un número elevado de combinaciones que, al sumar el descuento de errores ortográficos, dificulta el otorgamiento de la calificación correcta y requiere de mucho tiempo. La automatización de este proceso fue realizada por Santander Montes y colaboradores con el paquete profesional estadístico PSPP de libre distribución. Objetivo: Construir un instrumento en Excel para calificaciones de exámenes parciales y finales, de tres, cinco y siete preguntas, con descuento de errores ortográficos según los requisitos de la educación médica cubana. Métodos: Se utilizaron las herramientas de tabulación de información y fórmulas que ofrece el programa Excel de Microsoft Office 2013. Resultados: Se diseñó una interfaz simple, fácil de ejecutar. Se creó una secuencia para determinar en el instrumento: validez, confiabilidad, representatividad y factibilidad. Con la revisión reiterada de cinco profesores de manera independiente (1 Pediatría, 1 Medicina Interna y 3 Salud Pública) y la prueba piloto (examen final de Salud Pública de la carrera de medicina en el primer semestre del curso 2021-2022 en la Facultad Julio Trigo López"), se logró un instrumento de muy fácil uso, válido, confiable y accesible. Conclusiones: El instrumento en Excel propuesto proporciona una opción para automatizar el proceso de evaluación, evitando los errores que se cometen en la evaluación manual(AU)

Introduction: The evaluation of an exam of several questions generates a high number of combinations that, when adding the discount of spelling errors, makes it difficult to give the correct grade and requires a lot of time. The automation of this process was carried out by Santander Montes and collaborators with the professional statistical package PSPP of free distribution. Objective: To build an instrument in Excel for qualifications of partial and final exams, of three, five and seven questions, with spelling errors discounted according to the requirements of Cuban medical education. Methods: The information and formula tabulation tools offered by the Microsoft Office 2013 Excel program were used. Results: A simple interface was designed, easy to execute. A sequence was created to determine in the instrument: validity, reliability, representativeness and feasibility. With the repeated review of five professors independently (1 Pediatrics, 1 Internal Medicine and 3 Public Health) and the pilot test (final exam of Public Health of the medical career in the first semester of the 2021-2022 academic year in the Faculty Julio Trigo López), a very easy-to-use, valid, reliable and accessible instrument was achieved. Conclusions: The proposed instrument in Excel speeds up the evaluation process and avoids the errors that are made in manual evaluation(AU)

Estrategia de intervención de enfermería orientada al cuidado continuo en pacientes con cáncer de próstata

Fundamento: el cáncer de próstata está considerado un problema de salud a nivel mundial que afecta a los hombres de edad avanzada y de raza negra con mayor frecuencia. Objetivo: elaborar una estrategia de intervención de enfermería para mejorar la atención de salud de pacientes con el diagnóstico de neoplasias prostáticas y pene en el Centro de Salud Morete-Puyo de Ecuador. Métodos: se realizó un estudio descriptivo, transversal, prospectivo en el período mayo-octubre del 2021. Se estudiaron a 12 pacientes con cáncer de próstata con el diagnóstico de neoplasias prostáticas y pene en el Centro de Salud Morete-Puyo. Las variables analizadas fueron: distribución de pacientes con neoplasia prostática y de pene por edades; según causa de la enfermedad; relación entre el número de visitas domiciliarias y estadio de la enfermedad neoplásica. Se emplearon medidas de resumen para frecuencias absolutas y relativas. Los datos se presentaron en tablas de contingencia. Resultados: el grupo de mayor ocurrencia fue el de 63-73 años con 7 pacientes (58,33 %); la edad avanzada asociada al tabaquismo fue la principal causa presente en 9 pacientes (75 %), de los 12 pacientes 5 se encontraban en estadio IV del cáncer por lo que fue necesario realizarle 24 visitas domiciliarias, la atención domiciliaria fue la acción estratégica prioritaria para brindar un cuidado continuo. Conclusiones: la mayor ocurrencia de casos con cáncer de próstata se presentó en adultos mayores, fue la edad avanzada asociada con el tabaquismo la principal causa de la enfermedad, el estadio avanzado tuvo una relación directamente proporcional al número de visitas domiciliarias y se propusieron acciones estratégicas orientadas a un cuidado continuo para mejorar la atención de enfermería al paciente con padecimientos oncológicos.

Background: prostate cancer is considered a worldwide health problem that affects elderly and black men more frequently. Objective: to develop a nursing intervention strategy to improve the health care of patients diagnosed with prostatic and penile neoplasms at the Morete-Puyo Health Center in Ecuador. Methods: a descriptive, cross-sectional, prospective study was carried out in the period May-October 2021. 12 patients with prostate cancer with a diagnosis of prostatic and penile neoplasms were studied at the Morete-Puyo Health Center. The variables analyzed were: age distribution of patients with prostatic and penile neoplasia; according to the cause of the disease; relationship between the number of home visits and the stage of the neoplastic disease. Summary measures for absolute and relative frequencies were used. Data were presented in contingency tables. Results: the group with the highest occurrence was that of 63-73 years with 7 patients (58.33 %); advanced age associated with smoking was the main cause present in 9 patients (75 %). Of the 12 patients, 5 were in stage IV cancer, so it was necessary to make 24 home visits. Home care was the priority strategic action to provide ongoing care. Conclusions: the highest occurrence of cases with prostate cancer occurred in older adults, advanced age associated with smoking was the main cause of the disease, the advanced stage was directly proportional to the number of home visits and strategic actions were proposed. aimed at continuous care to improve nursing care for patients with oncological conditions.

O papel da herança cultural nos processos de ingresso na carreira diplomática brasileira entre 1995-2015 / El papel del patrimonio cultural en los exámenes de admisión a la carrera diplomática brasileña entre 1995-2015 / The role of cultural heritage in the admission exams for the Brazilian diplomatic career between 1995-2015

Resumo A seleção de novos membros para ocupar cargos na estrutura burocrática federal brasileira mudou progressivamente durante a segunda metade da década de 1990. Se a orientação inicial foi marcada pela retomada quantitativa dos concursos públicos federais (1995-2002), após 2003 a tendência foi de buscar atrair uma maior diversidade de setores sociais nas carreiras públicas - e a seleção de diplomatas não ficou alheia a este processo. A análise qualitativa de fontes primárias (documentos) e fontes secundárias (revisão de literatura) permitiu verificar que, juntamente com iniciativas já reconhecidas na literatura - aumento do número de vagas e da remuneração, isenção de inscrição, entre outras -, a própria modificação das questões formuladas nas provas aplicadas entre 1995 e 2015 pode ser entendida como uma medida com o objetivo de alteração do perfil dos ingressantes na carreira diplomática. Entre 1995 e 2004, a prova avaliou e selecionou os candidatos mediante questões de "cultura geral", que privilegiavam uma certa "herança cultural" reputada como sinal de distinção social e associada a um perfil social pretensamente sofisticado. No entanto, entre 2004 e 2015 parece ter havido uma padronização das novas questões, que, afastando-se das exigências tácitas de refinamento cultural, dariam preferência a outros perfis de candidatos.

Resumen La selección de nuevos miembros para ocupar los cargos públicos federales brasileños cambió progresivamente durante la segunda mitad de la década de 1990. Si la orientación inicial estuvo marcada por la reanudación cuantitativa de los concursos públicos federales (1995-2002), en el período posterior a 2003 esta tendencia buscó atraer una mayor diversidad de sectores sociales a las carreras públicas - y la selección de diplomáticos no quedó ajena a este proceso. El análisis cualitativo de fuentes primarias (documentos) y fuentes secundarias (revisión bibliográfica) permitió constatar que, junto a iniciativas ya reconocidas en la literatura - aumento del número de vacantes y remuneración, exención de registro, entre otras -, se puede entender la modificación de las preguntas formuladas en los exámenes aplicados entre 1995 y 2015 como una medida hacia la alteración del perfil de quienes ingresan a la carrera diplomática. Entre 1995 y 2004 la prueba evaluó y seleccionó a los candidatos a través de preguntas de "cultura general", que privilegiaron un "patrimonio cultural" reputado como signo de distinción social y asociado a un perfil social supuestamente sofisticado. Sin embargo, entre 2004 y 2015 parece haberse producido una estandarización de las nuevas preguntas, que, alejándose de las exigencias tácitas del refinamiento cultural, darían preferencia a otros perfiles de candidatos.

Abstract The selection of new members to occupy positions in the Brazilian federal bureaucratic framework changed progressively during the second half of the 1990s. If the initial orientation was characterized by the quantitative resumption of federal public tenders (1995-2002), post-2003, this trend sought to attract a greater diversity of social sectors in public careers — and the selection of diplomats was not alien to this process. The qualitative analysis of primary sources (documents) and secondary sources (literature review) showed that, along with initiatives already recognized in the literature — increase in the number of vacancies and remuneration, exemption from registration, among others — the very modification of questions formulated in the exams applied between 1995 and 2015 can be understood as a measure toward the alteration of the profile of those entering the diplomatic career. Between 1995 and 2004, the test evaluated and selected the candidates through questions of "general culture," which privileged a certain "cultural heritage" reputed as a sign of social distinction and associated with an allegedly sophisticated social profile. However, between 2004 and 2015, there seems to have been a standardization of the new questions, which, moving away from the tacit requirements of cultural refinement, gave preference to other candidate profiles.

Ensino do exame respiratório: o que é história e o que é necessidade? / Teaching the respiratory physical examination: what is history and what is needed?

A semiologia é uma das técnicas mais utilizadas na prática médica há séculos. Ensinada por meio de roteiros sistematizados, estudantes de inúmeras escolas da área de saúde por todo o mundo aprendem as manobras semiológicas como fundamento na avaliação dos pacientes. No entanto, apesar de extremamente difundida, discute-se pouco sobre sua acurácia como manobra diagnóstica. Tendo este ponto em vista, este artigo aborda a precisão das diversas manobras semiológicas do exame físico do aparelho respiratório e a descrição comparativa do seu ensino em diferentes escolas médicas no mundo. Como resultados, tem-se valores de acurácia discordantes, o que pode ser justificado pela qualidade dos estudos ou pelas variáveis analisadas que diferem entre os estudos e propostas de padronização. Em conclusão, a semiologia é a base da avaliação médica, independentemente dos avanços e disponibilidade dos exames de imagens, e cada manobra deve ser ensinada com seu devido valor científico. Conhecer a aplicabilidade e individualizar a prática das etapas do exame respiratório pode ser um caminho possível de adequação aos tempos atuais, sem impor perdas de informações relevantes para o desenvolvimento do raciocínio clínico (AU)

Medical semiology has been one of the most common techniques used in medical practice for centuries. Health science students around the globe learn these techniques through a systematized model as a fundamental skill for patient evaluation. However, though being widespread, little is known about semiology's true accuracy as a diagnostic maneuver. Knowing that, through a literature review, this paper evaluated the precision of the preconized procedures that are used as part of the exam of the respiratory system and the comparative description of its teaching in different medical schools around the world. As a result, disagreement between several papers was found, which can be justified by the poor quality of the studies and the different variables that were studied in each one. However, one thing is still clear: respiratory physical examination continues to be essential in medical practice, independently of the recent advances and availability of imaging exams. Teaching each step should consider available scientific evidence. The knowledge of the applicability and practical individualization of the respiratory examination can be a possible way for the current times without missing relevant information for developing clinical reasoning (AU)

Study the Impact of Cramming in Medical Students

Aim:To reveal pre-exam cramming among pre-clinical medical students, what drives this practice, failure due to cramming and the problems and difficulties related to the act of cramming.Discussion:Cramming is common practice among struggling medical students. The prevalence of cramming is like an iceberg phenomenon. The act of stacking too many information just the night before an exam probably authorize the perpetrator to remember some information in the short term period and enable them to take in enough information for the exam. Along with this practice also comes sleep deprivation, mental and emotional disturbances and even substance abuse in order to achieve good marks and passing the exam. Unfortunately for some experts, cramming is not considered as learning. Procrastination and some other reason are believed to be the reason the culprit commits cramming. Conclusion:Cramming not only changes the behavior of the perpetrator, but also has an impact on his family, classmates, environment and future.

Calidad de la evaluación en estomatología en el período 2014-2021 / Quality of the evaluation in the dental medicine major in the period 2014-2021

Introducción: La ampliación de la matrícula en la carrera de estomatología y la apertura de nuevos escenarios docentes descentralizados han constituido un reto en la formación de los educandos. Con el ejercicio del examen estatal se certifica la competencia de los egresados. Objetivo: Comparar los resultados de la evaluación final de la asignatura Atención integral a la población con los del examen ordinario estatal de la carrera de estomatología en los escenarios docentes descentralizados de Plaza de la Revolución. Métodos: Se realizó una investigación descriptiva y transversal de los resultados del examen ordinario estatal de la carrera de estomatología en el período 2014-2021, en los escenarios docentes descentralizados de Plaza de La Revolución. Los resultados finales se compararon con la nota final de la asignatura Atención integral a la población. Se trabajó con el universo de los estudiantes (161). Se utilizaron los números enteros y el porcentaje. Resultados: Los resultados de la asignatura Atención integral a la población fueron ligeramente superiores a los obtenidos en la prueba estatal. En ambos predominaron las calificaciones de alto rendimiento, para un 69,5 por ciento y un 57,1 por ciento respectivamente. Conclusiones: La calidad satisfactoria de los resultados docentes de los exámenes finales de Atención integral a la población y el estatal se mantuvieron con una tendencia a la mejoraría de las calificaciones de los últimos tres cursos(AU)

Introduction: An increase in the enrollment acceptance for the dental medicine major and the creation of new decentralized teaching settings have become challenges with respect to the training of students. The state examination certifies the competence of graduates. Objective: To compare the results of the final evaluation corresponding to the subject of Comprehensive Population Care with the results of the first call for the state examination corresponding to the dental medicine major in the context of decentralized teaching settings of Plaza de la Revolución Municipality, Havana, Cuba. Methods: A descriptive and cross-sectional research was carried out with the results of the first call for the state examination corresponding to the dental medicine major in the period 2014-2021, in the context of decentralized teaching settings of Plaza de La Revolución Municipality. The final results were compared with the final scores corresponding to the subject of Comprehensive Population Care. The universe of students (161) were included. Integer numbers and percentages were used. Results: The results corresponding to the subject of Comprehensive Population Care were slightly higher than the results obtained in the state examination. Both were characterized by predominantly high performance scores, accounting for 69.5 percent and 57.1 percent, respectively. Conclusions: The satisfactory quality of the teaching results corresponding to the final exams for the subject of Comprehensive Population Care and the state examination maintained a tendency of improving scores in the last three academic years(AU)

Revisión de las pruebas cognitivas breves para pacientes con sospecha de demencia / Review of brief cognitive tests for patients with suspected dementia

RESUMEN NTRODUCCIÓN: Para ser útiles, las pruebas cognitivas breves (PCB) deben ser rápidas, sensibles, fáciles de realizar y no necesitar de un gran entrenamiento para hacerlo. Las pruebas cognitivas breves comúnmente utilizadas incluyen el Mini Examen del Estado Mental (MMSE) y la Evaluación Cognitiva de Montreal (MoCA). OBJETIVO: Brindar una descripción de las PCB disponibles y sus propiedades psicométricas para la detección de la demencia. MÉTODOS: Revisión narrativa RESULTADOS: El MMSE le otorga un gran peso a la orientación, la memoria, la visuo-espacialidad y el lenguaje, y, en consecuencia, puede ser sensible a los déficits cognitivos encontrados en la demencia tipo Alzheimer. MoCA es una prueba breve más compleja que evalúa una gama más amplia de dominios cognitivos, especialmente funciones ejecutivas, proporcionando una mayor sensibilidad para detectar el deterioro cognitivo leve y otros tipos de demencia, no solo la demencia tipo Alzheimer. CONCLUSIONES: Las PCB son parte del arsenal necesario para ayudar a confirmar la sospecha de la demencia. La escolaridad tiene un impacto importante en el desempeño de las PCB y puede sesgar la interpretación de los resultados obtenidos.

ABSTRACT INTRODUCTION: To be useful, Brief Cognitive Tests (BCTs) must be fast, sensitive, easy to perform, and not require extensive training to do so. Commonly used brief cognitive tests include the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). OBJECTIVE: To provide a description of the available BCTs and their psychometric properties for the detection of dementia. METHODS: Narrative review RESULTS: The MMSE places great weight on orientation, memory, visuospatiality, and language, and, consequently, may be sensitive to the cognitive deficits found in Alzheimer's dementia. MoCA is a more complex brief test that assesses a broader range of cognitive domains, especially executive functions, providing greater sensitivity for detecting mild cognitive impairment and other types of dementia, not just Alzheimer's dementia. CONCLUSIONS: BCTs are part of the arsenal needed to help confirm suspected dementia. Schooling has an important impact on the performance of BCTs and can bias the interpretation of the results obtained.

Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears / Agentes causadores de infecções genitais em exames citológicos de rotina: frequência e características dos esfregaços de papanicolaou

Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Infecções do trato urinário são responsáveis pela maior parte das infecções humanas, sendo causadas por bactérias, fungos, protozoários, e por microrganismos associados. O objetivo deste trabalho foi determinar a frequência de agentes causadores de infecções vaginais nos exames citológicos de rotina, bem como avaliar as características dos esfregaços positivos. Foi realizada uma pesquisa do tipo documental retrospectiva de aspecto descritivo, com abordagem quantitativa, em um Laboratório de Patologia Clínica de Maceió-AL. Nesse sentido, os resultados dos exames colpocitológicos para Trichomonas vaginalis, Gardnerella vaginalis, Candida spp e HPV foram organizados em um banco de dados, contendo os resultados para estes agentes, bem como a coinfecção bacteriana, protozoária, fúngica e viral. A amostra foi composta por 18.645 mulheres que realizaram exame colpocitológico, no período de 2013 a 2017. Destes exames analisados 27,4% em 2013, 10,9% em 2014, 10,6% em 2015, 15,2% em 2016 e 13,67% em 2017, estavam dentro do limite da normalidade, porém mais que a metade desses exames analisados apresentou algumas infecções causadas por agentes inespecíficos ou microbiológicos. Do total de laudos analisados, 4.073 (21,84%), apresentaram inflamações causadas por algum tipo de agente infeccioso, com a seguinte ordem de frequência: G. vaginalis, e T. vaginalis. Além disto, foi possível confirmar a elevada frequência de coinfecção entre G. vaginalis e Candida spp. Os índices de infecções genitais nesse trabalho mostram que há um problema de saúde pública que deve ser controlado, apontando uma necessidade maior de acompanhamento, orientações e de ações para uma maior conscientização para prevenir esses problemas.

Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears

Abstract Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Resumo Infecções do trato urinário são responsáveis pela maior parte das infecções humanas, sendo causadas por bactérias, fungos, protozoários, e por microrganismos associados. O objetivo deste trabalho foi determinar a frequência de agentes causadores de infecções vaginais nos exames citológicos de rotina, bem como avaliar as características dos esfregaços positivos. Foi realizada uma pesquisa do tipo documental retrospectiva de aspecto descritivo, com abordagem quantitativa, em um Laboratório de Patologia Clínica de Maceió-AL. Nesse sentido, os resultados dos exames colpocitológicos para Trichomonas vaginalis, Gardnerella vaginalis, Candida spp e HPV foram organizados em um banco de dados, contendo os resultados para estes agentes, bem como a coinfecção bacteriana, protozoária, fúngica e viral. A amostra foi composta por 18.645 mulheres que realizaram exame colpocitológico, no período de 2013 a 2017. Destes exames analisados 27,4% em 2013, 10,9% em 2014, 10,6% em 2015, 15,2% em 2016 e 13,67% em 2017, estavam dentro do limite da normalidade, porém mais que a metade desses exames analisados apresentou algumas infecções causadas por agentes inespecíficos ou microbiológicos. Do total de laudos analisados, 4.073 (21,84%), apresentaram inflamações causadas por algum tipo de agente infeccioso, com a seguinte ordem de frequência: G. vaginalis, e T. vaginalis. Além disto, foi possível confirmar a elevada frequência de coinfecção entre G. vaginalis e Candida spp. Os índices de infecções genitais nesse trabalho mostram que há um problema de saúde pública que deve ser controlado, apontando uma necessidade maior de acompanhamento, orientações e de ações para uma maior conscientização para prevenir esses problemas.

Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears / Agentes causadores de infecções genitais em exames citológicos de rotina: frequência e características dos esfregaços de papanicolaou

Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Infecções do trato urinário são responsáveis pela maior parte das infecções humanas, sendo causadas por bactérias, fungos, protozoários, e por microrganismos associados. O objetivo deste trabalho foi determinar a frequência de agentes causadores de infecções vaginais nos exames citológicos de rotina, bem como avaliar as características dos esfregaços positivos. Foi realizada uma pesquisa do tipo documental retrospectiva de aspecto descritivo, com abordagem quantitativa, em um Laboratório de Patologia Clínica de Maceió-AL. Nesse sentido, os resultados dos exames colpocitológicos para Trichomonas vaginalis, Gardnerella vaginalis, Candida spp e HPV foram organizados em um banco de dados, contendo os resultados para estes agentes, bem como a coinfecção bacteriana, protozoária, fúngica e viral. A amostra foi composta por 18.645 mulheres que realizaram exame colpocitológico, no período de 2013 a 2017. Destes exames analisados 27,4% em 2013, 10,9% em 2014, 10,6% em 2015, 15,2% em 2016 e 13,67% em 2017, estavam dentro do limite da normalidade, porém mais que a metade desses exames analisados apresentou algumas infecções causadas por agentes inespecíficos ou microbiológicos. Do total de laudos analisados, 4.073 (21,84%), apresentaram inflamações causadas por algum tipo de agente infeccioso, com a seguinte ordem de frequência: G. vaginalis, e T. vaginalis. Além disto, foi possível confirmar a elevada frequência de coinfecção entre G. vaginalis e Candida spp. Os índices de infecções genitais nesse trabalho mostram que há um problema de saúde pública que deve ser controlado, apontando uma necessidade maior de acompanhamento, orientações e de ações para uma maior conscientização para prevenir esses problemas.

Construction and application of medical morphology online picture examination system / 中华医学教育探索杂志

At present, the experimental examination of medical morphology courses in most medical colleges and universities still adopt traditional specimen examination or PPT examination, and there are many disadvantages. This paper introduces how to build a system with B/S architecture based on the local area network, and how to set up an examination system to realize the functions of user management, online examination database updating, free examination paper formation, examination running and automatic marking. Through its application in Chengdu Medical College in recent years, the medical morphology online picture exam system has effectively promoted the reform of the examination methods, the style of study and the effect of experimental teaching. However, there are still some problems, such as high investment cost and limited examination room.

Quality of Life of Elderly People Living in Different Types of Long-term Care Facilities

Abstract Population aging is a worldwide occurrence that has become urgent in developing countries. Quality of life can be measured to identify functional capacity and determine the degree of impact on quality of life exerted on an individual. This study aimed to measure the quality of life of elderly people who have been living in different long-term care facilities for the elderly. Therefore, this research was developed with a qualitative and descriptive approach. Data were obtained from medical records and interviews, and were analyzed in R language interpreter software on the Ubuntu Linux operating system. Seventy-nine elderly people participated in the study. Eleven lived in Home Marista, and 68 lived in Home Jesus Maria José. A socioeconomic questionnaire was used to collect data on the socioeconomic characteristics of the participants. The Mini-Mental State Exam was used to measure degree of cognition. The Short Form-36 Questionnaire was used to measure quality of life. The present study suggests that the results found can clarify the individual vulnerability of the elderly in the age group studied regardless of the type of residence. Despite the discrepancy found regarding the care provided at the long-term care facilities, the scores, obtained with the quality of life assessment, did not show significant differences.

Análisis comparativo de evaluaciones de parasitología / Comparative analysis of parasitology evaluations

El cambio curricular es un proceso de transformaciones que expresa las modificaciones operadas en la sociedad en términos epidemiológicos, frente a la emergencia y reemergencia de parasitosis, en estrecha relación con la geografía médica y los condicionamientos sociales, económicos y políticos bajo los que se desarrolla la sociedad; por tanto, reconocer y tratar los principales parásitos que afectan al hombre y las enfermedades parasitarias asociadas a ellos resulta esencial para la formación médica de estos tiempos. La presente investigación tiene como objetivo comparar los resultados en las calificaciones en el examen de parasitología del 9no semestre de dos de las universidades públicas de la provincia del Guayas, Ecuador, en el periodo de noviembre de 2020. Se realizó un estudio exploratorio/descriptivo de la variable "Evaluación", que contuvo medidas de posición, dispersión y contraste de la normalidad, y el desempeño fue determinado mediante las listas de apreciación de competencias, establecido como instrumento de evaluación. De igual forma, se utilizó la técnica estadística de comparación de medias a través de la Prueba t para muestras independientes con un nivel de significancia del (5%). Los datos fueron procesados empleando el Programa Estadístico para Ciencias Sociales (SPSS v25). Concluyendo, que los estudiantes de la universidad de ESPOL tuvieron mejor puntuación en relación con la media, y menos dispersión en sus resultados con respecto a la UG. En líneas generales la mayoría de los estudiantes obtuvieron un alto desempeño de las competencias, siendo fundamental la constancia en la mejora del proceso de enseñanza de la parasitología(AU)

Curriculum change is a transformation process that expresses the changes that have taken place in society in epidemiological terms, in the face of the emergence and re-emergence of parasites, in close relation to the medical geography and the social, economic and political conditions under which society develops; therefore, recognizing and treating the main parasites that affect man and the parasitic diseases associated with them is essential for medical training in these times. The objective of this research is to compare the results in the qualifications in the parasitology exam of the 9th semester of two of the public universities of the province of Guayas, Ecuador, in the period of November 2020. An exploratory/descriptive study of the variable "Evaluation", which contained measures of position, dispersion and contrast of normality, and performance, was determined through the competency assessment lists, established as an evaluation instrument. Similarly, the statistical technique of comparison of means was used through the t-test for independent samples with a significance level of (5%). The data was processed using the Statistical Program for Social Sciences (SPSS v25). Concluding, that the students of the ESPOL University had a better score in relation to the average, and less dispersion in their results with respect to the UG. In general terms, most of the students obtained a high performance of the competences, being fundamental the constancy in the improvement of the parasitology teaching process(AU)

La evaluación de las competencias investigativas en el examen final estatal de la especialidad / Evaluation of investigative competences in the state final exam of this specialty

El desarrollo de competencias investigativas en el profesional de la Medicina es una necesidad incuestionable. En este sentido, la residencia, como forma de educación de posgrado, debe tener una función relevante. En este artículo se analizan especificidades relacionadas con la evaluación del componente trabajo de terminación de la especialidad, correspondiente a la evaluación de graduación o examen final estatal. Las acciones y modificaciones que se proponen persiguen como propósito que la presentación y defensa del trabajo de tesis constituya un verdadero exponente de actividad científica, para lo cual se requiere de un proceso formativo que las valorice, y en el cual se involucren, responsablemente, tutores y residentes(AU)

The development of investigative competences in the medical professional is an unquestionable need. In this sense, residency, as a form of postgraduate education, must have a relevant function. This article analyzes specificities related to the evaluation of the component work of completion of the specialty, corresponding to the graduation evaluation or state final exam. The actions and modifications that are proposed pursue the purpose that the presentation and defense of their thesis work constitute a true exponent of scientific activity, for which a training process is required that values them, and in which tutors and residents are responsibly involved(AU)