A study on reducing nonfunctional distractors of multiple-choice questions in medical examination / 中华医学教育探索杂志

Objective:To discuss the possibility of modifying nonfunctional distractors to improve the quality of multiple-choice questions in medical examination through analyzing the changes in the difficulty and discrimination of items and the selection rate of modified distractors.Methods:Thirty-two multiple-choice questions involving nonfunctional distractors from a medical examination were studied. According to the item-writing guidelines, experts modified nonfunctional distractors based on actual measurements. We analyzed the changes in the difficulty and discrimination of items and the selection rate of modified distractors before and after item modification using the paired Wilcoxon test, and investigated the correlation of item difficulty and discrimination before and after item modification by Spearman's rank correlation analysis.Results:Six questions were modified due to technical factors, and 26 questions were modified due to weak interference in knowledge content. Before and after nonfunctional distractor modification, the difficulty values of the questions were 0.676 (0.558, 0.893) and 0.637 (0.531, 0.839), respectively; the discrimination values (point-biserial correlation) were 0.261 (0.150, 0.316) and 0.262 (0.138, 0.358), respectively; and the discrimination index values were 0.215 (0.113, 0.352) and 0.259 (0.138, 0.346), respectively. There were significant differences in the difficulty and discrimination index of items before and after modification. The difficulty and discrimination of items before and after modification were both significantly correlated. The selection rates of modified distractors were 0.009 (0.003, 0.015) and 0.044 (0.021, 0.092) before and after modification, respectively, which were significantly different.Conclusions:Nonfunctional distractors in this study were mainly caused by reasons in the contents of the test questions, less in technical defects. Through the analysis and modification of nonfunctional distractors, the selection rate of nonfunctional distractors can be effectively increased, and item difficulty and discrimination can be improved.

Standardizing the forensic medical reports for enhancing the credibility of forensic science / 中国法医学杂志

The decreasing reliability of forensic medical reports led to the inadequate credibility of forensic science.Therefore,we can improve the credibility of forensic science by improving the reliability of forensic medical reports.The reliability assessment of the forensic medical examination is presented by the final reports.Standardized production of forensic medical reports can not only reflect the reliability of the related forensic service,but also improve such forensic activities by reversing supervision.The standardized preparation of forensic medical reports is the final positive step when improving the reliability of justice.Therefore,it is necessary to improve the standardization of forensic medical reports from the micro perspective,in order to help enhance the credibility of forensic science,which will finally lead to the enhancement of the credibility of the judicial activities.

Discussion on the managing mode for suspected illegal and irregular acts in occupational medical examination institutions / 中国职业医学

ObjectiveTo establish a managing mode for illegal and irregular acts of occupational medical examination (OME) institutions to the requirements of the new situation. Methods The OME institutions from the “Guangdong Province Key Occupational Disease Monitoring and Management Platform” were selected as the study subjects using the judgment sampling method. The clues of suspected illegal and irregular acts of OME institutions were found and submitted to the local health commission for investigation and managed according to the case information monitoring and on-site quality assessment. The OME institutions found to have illegal and irregular acts were filed and investigated according to the national law after investigation and verification. A “follow-up inspection” was conducted on five OME institutions for closed loop management. Results A total of 12 OME institutions were found to have suspected illegal and irregular acts, including seven institutions that did not meet the filing requirements for effective personnel, five institutions that conducted projects beyond the scope without filing to the provincial health authorities within 15 work days from the start of the project, and two institutions that failed to fulfill the obligation of informing and reporting to the health authorities, employers, and workers as required. After submitting relevant clues and evidence to the local health commission for investigation and management, seven institutions were not given penalty, and five institutions were given administrative penalties including two institutions were fined and warned, and three institutions were warned. No illegal or irregular acts were found in the five institutions inspected during the “follow-up inspection”. Conclusion It is beneficial to explore the managing mode of “clue discovery, clue submission, investigation and disposal, follow-up inspection” for OME institutions suspected of illegal and irregular acts, which helps urge OME institutions to work in accordance with laws and regulations and effectively protect the legitimate rights and interests of workers' occupational health.

Analysis of current status and risk of development in occupational medical examination institutions in Guangdong Province / 中国职业医学

Objective: To analyze the status of occupational medical examination (OME) institutions in Guangdong Province and the critical control points affecting their future development. Methods: A total of 211 OME institutions registered in Guangdong Province were selected as the research subjects. Their current statue was investigated, and the risk assessment of their future development was carried out based on hazard analysis and critical control point theory. Results: The OME institutions were mainly concentrated in the Pearl River Delta, accounting for 72.0%. The public and private medical and health institutions accounted for 70.6% and 29.4% respectively. The filing rates of different OME categories from high to low in the order were physical factors, chemical factors, dust, other, radiation factors, biological factors (P<0.01), and the filing rates were 89.6%, 88.6%, 84.8%, 63.0%, 7.1% and 1.0%, respectively. The rates of excellence in the field assessment from high to low in the order were hearing atlas analysis personnel, lung function examination operators, chest film reading personnel, chief examination physician, technical director, quality director (P<0.01), and the rates of excellence were 49.4%, 26.2%, 20.6%, 10.8%, 8.2% and 4.6%, respectively. A total of 37 institutions did not submit OME information, of which 23 institutions did not carry out OME work after filing. The required diagnosis rate and confirmed diagnosis rate of suspected occupational diseases in 2020 were 34.3% and 55.3%, respectively. In 2021, the detection rate of suspected occupational diseases was only 1.1‰. Among the institutions with biological monitoring records, 64.1% did not participate in external quality assessment program in laboratory, and the unqualified rate of 38 participating institutions was 55.3%. The risk assessment results show that the future development of OME institutions needs to focus on private institutions, institutions that have not reported OME information, institutions that have missed diagnosis and missed reporting of suspected occupational diseases, institutions that have not participated in external quality assessment program in laboratory and core personnel such as quality managers, technical leaders, and main inspection physicians. Conclusion: OME institutions in Guangdong Province show the characteristics of centralized filing category, centralized filing region and centralized filing institution nature. Combined with the potential risks of OME institutional capacity building, it is necessary to implement classified management, strengthen information construction, supervision and management, implement post responsibilities, and promote the high-quality development of OME institutions.

Inspiration of different medical examination forms of Medical University of Vienna in Austria to medical education in china / 中华医学教育探索杂志

Medical students need to have different levels of ability, so various examination forms are required to measure on levels of competency. The choice of different examination methods is very important to reflect the learning effect of the selected courses. The present work describes the examination design and its functions of the Medical University of Vienna, and the enlightenment to the evaluation of higher medical education of China. Learning from the advanced teaching evaluation concepts and methods in Austria may help to promote the reform of medical education evaluation methods and cultivate high-quality medical talents in our country.

Analyzing the monitoring results of noise hazards in workplace of key industries in Guangdong Province in 2019 / 中国职业医学

Objective: To analyze the status of noise hazard in workplace of key industries in Guangdong Province. Methods: A total of 1 061 enterprises from 14 key industries in 21 prefecture-level cities in Guangdong Province were selected as the research subjects using stratified sampling method. The occupational health survey was carried out, and the noise intensity in the workplace was detected. Results: There were 12 606 workplaces and 5 570 work sites involved among 1 061 enterprises. The median and the 0-100th percentile value ［M (P0-P100)］ of noise intensity in workplace were 82.6 (46.5-112.6) dB(A), and 35.03% of the workplace exceeded the national noise intensity standard. The regions and industry with the highest rate of noise exceeded the national noise intensity standard in workplace were in the northern part of Guangdong and the stone processing industry respectively. The M (P0-P100) of noise intensity in the work sites was 83.7 (47.5-106.2) dB(A), and 36.00% of the work sites exceeded the national noise intensity standard. The regions and industry with the highest rate of noise exceeded the national noise intensity standard in work sites were in the Pearl River Delta region and the ferrous metal mining and dressing industry respectively. The rate of noise protection facilities setting was 66.45%, and the validity of personal protection was 61.73%. The occupational medical examination was performed in 73.24% of the research subjects, and 3.25% of the result was abnormal. The industry with the highest occupational medical examination rate was nonferrous metal smelting and rolling processing, and the industry with the highest abnormal rate of occupational medical examination was stone processing industry. Conclusion: Noise hazards in workplaces of key industries in Guangdong Province are relatively severe, necessitating strengthened supervision and management, noise control measures, and efforts to reduce noise exposure levels in workplaces and work sites.

Introduction to revision of Technical Specification for Occupational Health Surveillance / 中国职业医学

To revise GBZ 188 Technical Specification for Occupational Health Surveillance based on national laws, regulations, standards, specifications and legal documents of occupational disease, and combination with the actual situation in China. The main modifications are as follows: the occupational health surveillance for workers exposed to toluene (xylene may implement by reference), bromopropane, methyl iodide, ethylene oxide, chloroacetic acid, indium and its compounds, coal tar, coal tarasphalt, asphalt, β-naphthylamine, dust of metal and its compounds(tin, iron, antimony, barium and its compounds), hard metal dust, erionite dust, low temperature, laser, tick-borne encephalitis virus, Borrelia burgdorferi, and human immunodeficiency virus, for scraper or grind operators, and underground workers using squatting or kneeling position, crawling position, side-lying position, or shoulder position for a long period of time are included. The emergency health screening for workers exposed to arsenic, fluorine and its inorganic compounds, and acrylamide are included. The occupational medical examination (OME) for workers exposed to amino and nitro compounds of benzene, phosgene, monomethylamine, organic fluorine and dimethyl sulfate has been adjusted and made mandatory, with corresponding assessments required upon leaving the job. The special occupational health surveillance for workers exposed to mycobacterium tuberculosis and hepatitis virus is removed. The OME conclusion of reexamination is removed, and standardize recheck/additional inspection requirements. The optional items in OME performed before, during and after leaving post are removed, but the optional items in emergency medical examination are retained. Additional OME items are added. The Guideline for OME Summary Reports is added as informative appendix, and so on. The revised GBZ 188 Technical Specification for Occupational Health Surveillance is more scientific and practical.

Relationship between sportive capacities and athletic potential in the individual with chronic diseases / Relação entre capacidades esportivas e potencial atlético no indivíduo portador de doenças crônicas / Relación entre las capacidades deportivas y el potencial atlético en el individuo con enfermedades crónicas

ABSTRACT Introduction Success in sports depends on the athlete's potential, including the presence of chronic diseases that can negatively affect a sports career. The issue studied is complex, and its solution depends on a combination of factors that act as basal components. The relevance of the research topic mentioned here is determined by the need to study the relationship between these two factors in the context of their mutual influence on an individual's sports career development prospects. Objective This scientific study aims to establish a relationship between sports skills and athletic potential in an individual with chronic diseases. Methods The main approach of this study was a combination of systemic analysis of the relationship between various aspects of an individual's talent with the development of his sports career, a theoretical understanding of the relationship of this factor, and the influence of chronic diseases on sport activity. Results The main results obtained in this scientific study should be considered the determination of the quality of an athlete's achievements on his natural talent and the influence of chronic diseases. Conclusion The prospects for future scientific research in this direction are determined by a real need for the search for and practical application of methods to determine the dependence of sporting achievements on factors included in the theme of this scientific work. The applied value of this scientific study lies in the possibility of the practical application of its results to form such methods for future approaches. Evidence level II; Therapeutic studies - outcomes research.

RESUMO Introdução O sucesso no esporte depende do potencial do atleta, incluindo da presença de doenças crônicas que podem afetar negativamente uma carreira esportiva. A questão estudada é complexa e sua solução depende de uma combinação de fatores que atuam como componentes basais. A relevância do tema de pesquisa mencionado neste caso é determinada pela necessidade de estudar a relação entre estes dois fatores no contexto de sua influência mútua sobre as perspectivas de desenvolvimento da carreira esportiva de um indivíduo. Objetivo O objetivo deste estudo científico é estabelecer uma relação entre as capacidades esportivas e o potencial atlético em um indivíduo portador de doenças crônicas. Métodos A abordagem principal deste estudo foi uma combinação de análise sistêmica da relação entre vários aspectos do talento de um indivíduo com o desenvolvimento de sua carreira esportiva, uma compreensão teórica da relação deste fator e da influência de doenças crônicas na atividade esportiva. Resultados Os principais resultados obtidos no decorrer deste estudo científico devem ser considerados segundo a determinação da dependência da qualidade das realizações de um atleta em relação a seu talento natural e a influência das doenças crônicas. Conclusão As perspectivas de futuras pesquisas científicas nesta direção são determinadas por uma real necessidade de busca e aplicação prática de métodos para determinar a dependência das conquistas esportivas de fatores incluídos no tema deste trabalho científico. O valor aplicado deste estudo científico encontra-se na possibilidade de aplicação prática de seus resultados, com o objetivo de formar tais métodos para futuras abordagens. Evidência nível II; Estudos terapêuticos - pesquisa de resultados.

RESUMEN Introducción El éxito en el deporte depende del potencial del atleta, incluyendo la presencia de enfermedades crónicas que pueden afectar negativamente a la carrera deportiva. La cuestión estudiada es compleja y su solución depende de una combinación de factores que actúan como componentes basales. La pertinencia del tema de investigación mencionado en este caso viene determinada por la necesidad de estudiar la relación entre estos dos factores en el contexto de su influencia mutua en las perspectivas de desarrollo de la carrera deportiva de un individuo. Objetivo El objetivo de este estudio científico es establecer una relación entre las habilidades deportivas y el potencial atlético en un individuo con enfermedades crónicas. Métodos El enfoque principal de este estudio fue una combinación de análisis sistémico de la relación entre varios aspectos del talento de un individuo con el desarrollo de su carrera deportiva, una comprensión teórica de la relación de este factor y la influencia de las enfermedades crónicas en la actividad deportiva. Resultados Los principales resultados obtenidos en el curso de este estudio científico deben considerarse según la determinación de la dependencia de la calidad de los logros de un atleta de su talento natural y la influencia de las enfermedades crónicas. Conclusión Las perspectivas de futuras investigaciones científicas en esta dirección están determinadas por una necesidad real de búsqueda y aplicación práctica de métodos para determinar la dependencia de los logros deportivos de los factores incluidos en el tema de este trabajo científico. El valor aplicado de este estudio científico reside en la posibilidad de aplicación práctica de sus resultados, con el objetivo de formar dichos métodos para futuros planteamientos. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados.

Caracterização da atenção ao paciente com diabetes na atenção primária a partir do PMAQ-AB / Characterization of primary health care for patients with diabetes based on the PMAQ-AB

Resumo Este artigo tem o objetivo de apresentar uma proposta de compatibilização dos instrumentos utilizados nos três ciclos do PMAQ-AB e analisar as informações de acesso, cobertura, estrutura, organização e oferta de serviços na APS relacionadas ao cuidado para DM no Brasil, segundo regiões, a partir da perspectiva das equipes de saúde da família e dos usuários. Foi realizada uma análise do grau de compatibilidade das questões do PMAQ-AB (2012, 2014 e 2017). Para análise da evolução temporal dos componentes realizou-se teste de diferença de proporção. Calculou-se a diferença percentual entre a perspectiva das Equipes e dos Usuários, por ano analisado, para Brasil. Em geral, houve melhora da qualidade do cuidado e realização de exames, com exceção do pé diabético. Foram encontrados resultados piores para o Norte em relação às demais regiões. Apesar da melhora estrutural e na qualidade da atenção reportada pelas equipes, foram evidenciadas lacunas significativas na qualidade do cuidado ao paciente com DM no SUS. No cenário de investimento escasso e crescente prevalência de DM, os obstáculos tornam-se cada vez mais desafiadores e, por isso, o monitoramento e avaliação da qualidade dos serviços prestados são tarefas precípuas do SUS.

Abstract This article aims to present a proposal for making the instruments used in the three cycles of the PMAQ-AB compatible and to analyze the information on access, coverage, structure, organization and provision of services in PHC related to care for DM in Brazil, according to regions, from the perspective of family health professionals and users. We performed an analysis of the degree of compatibility of the PMAQ-AB questions (2012, 2014 and 2017). To analyze the temporal evolution of the components, we performed a proportion difference test. We calculated the percentage difference between the perspective of professionals and users, per year analyzed, for Brazil. In general, there was an improvement in the quality of care and examinations, except for the diabetic foot. Worse results were found for the North region in relation to the other regions. Despite the structural improvement and the quality of care reported by professionals, there are significant gaps in the quality of care for patients with DM in the SUS. In the scenario of scarce investment added to the growing prevalence of DM, obstacles become progressively more challenging. Therefore, monitoring and evaluating the quality of services provided are essential tasks of the Brazilian Health System.

Oferta e demanda de procedimentos atribuíveis ao diabetes mellitus e suas complicações no Brasil / Supply and demand of procedures related to diabetes mellitus and its complications in Brazil

Resumo Este artigo tem como objetivo apresentar uma metodologia de monitoramento dos procedimentos preconizados no protocolo de atenção ao paciente diabético a partir do indicador de razão entre a oferta e a demanda de exames, segundo nível nacional, macrorregiões, UF e municípios. A prevalência de diabetes mellitus (DM) e suas complicações foi estimada a partir de modelo multinomial. A oferta de procedimentos para DM foi obtida a partir do Sistema de Informações Ambulatoriais (SIA/SUS) e a demanda a partir do número de exames definidos no protocolo como necessários por ano, segundo categorias de risco da doença. A partir disso foi criado o indicador de razão entre oferta e demanda. A inovação que ora apresentamos consiste em analisar conjuntamente a demanda por cuidado ao diabético segundo parâmetros estabelecidos e a oferta de serviços de saúde. A conexão entre o protocolo de tratamento preconizado e a existência do serviço ofertado em relação da demanda de cuidado baseada na prevalência da doença disponibiliza uma ferramenta chave de monitoramento. E, quando analisado conjuntamente ao indicador de razão entre oferta e demanda de procedimentos, essas medidas tornam-se proxy da qualidade da prevenção e atenção ao portador da doença.

Abstract This article aims to present a methodology for monitoring the procedures recommended in the care protocol for diabetic patients, based on the indicator of the ratio between supply and demand for exams, according to Brazil, macro-regions, federative units (FUs), and municipalities. The prevalence of diabetes mellitus (DM) and its complications were estimated using a multinomial model. The offer of DM procedures was obtained from the Ambulatory Information System (SIA/SUS) and the demand from the number of tests defined in the protocol as necessary per year, according to disease risk categories. Based on this, the supply-demand ratio indicator was created. The innovation here consists of analyzing the demand for diabetic care according to established parameters and the supply of health services together. The connection between the recommended treatment protocol and the existence of the service offered concerning the demand for care based on the prevalence of the disease provides a key monitoring tool. And, when analyzed together with the indicator of the ratio between supply and demand for procedures, these measures become a proxy for the quality of prevention and care for patients with the disease.

Index design of core elements of health examination report and pilot data analysis / 中华健康管理学杂志

Objective:To analyze the core elements′ index design of physical examination reports and pilot data.Methods:We searched and analyzed the core element indexes of the physical examination report in databases such as CNKI and Wanfang through the literature analysis method, forming the initial core element indicator set. Special working meetings were organized to discuss revisions and improvements. The core elements′ index set was formed using a mixed research method combined with the quantitative analysis results of pilot data and expert opinions. Six hundred and thirteen cases from five hospitals were included in this study, including Anzhen Hospital, Peking University Third Hospital, Beijing Physical Examination Center, Beijing Tongren Hospital, China-Japan friendship hospital.Results:The subjects were (49.5±17.6) years old, including 302 males (49.3%) and 311 females (50.7%). The physical examination conclusion indicates that the number of health problems is between five and eight, with no significant difference between men and women. The health history data analysis of different sexes showed that hypertension in men was significantly higher than in women (17.9% vs. 10.6%, P=0.010). The lifestyle and eating habits survey showed that men had significantly higher incidences of smoking and drinking than women (24.8% vs. 2.2%, P?0.001; 9.9% vs. 1.3%, P?0.001). The exercise habits and sleep survey showed that the proportion of men who did not exercise was lower than that of women (13.2% vs. 22.8%, P=0.022). There was no statistically significant difference in sleep duration between the sexes. Conclusions:The core elements of health examination reports can standardize the collection of physical examination data and improve its sharing and application. This can allow the reports to better assist the decisions based upon physical examination report data.

Mapping the knowledge domain of occupational health research in China / 中国职业医学

@#Objective To map the knowledge domain of occupational health research in China. Methods Articles were searched in the China Academic Journal Network Publishing Database using“occupational health”as the subject term. Journal sources were limited to the journals of China Social Science Citation Index and core journals of China and Chinese Science Citation Database. The search period starts in 1992 and ends on November 26，2021. The valid data was visually analyzed using CiteSpace softwere. Results A total of 2 351 papers related to occupational health from 1992 to 2021 were obtained. In the past 30 years，the number of articles with the title of“occupational health”has been on the rise and reached its peak in 2014. China Occupational Medicine，Chinese Journal of Industrial Hygiene and Occupational Diseases，and Chinese Journal of Industrial Medicine were the top three journals in terms of number of articles published，which produced 438，339 and 280 articles respectively. Chinese Center for Disease Control and Prevention and Guangdong Province Hospital for Occupational Disease Prevention and Treatment were the top two organizations in terms of number of articles published，which produced 169 and 116 articles respectively. Occupational medical examination，occupational health surveillance，and occupational health risk assessment were the three hot issues in the field of occupational health research. Conclusions In the past 30 years， occupational health research in China has achieved remarkable progress in terms of article publications and interdisciplinary cooperation，and future work should focus on the academic impact of articles and interdisciplinary research cooperation.

Mapping the knowledge domain of occupational health research in China / 中国职业医学

@#Objective To map the knowledge domain of occupational health research in China. Methods Articles were searched in the China Academic Journal Network Publishing Database using“occupational health”as the subject term. Journal sources were limited to the journals of China Social Science Citation Index and core journals of China and Chinese Science Citation Database. The search period starts in 1992 and ends on November 26，2021. The valid data was visually analyzed using CiteSpace softwere. Results A total of 2 351 papers related to occupational health from 1992 to 2021 were obtained. In the past 30 years，the number of articles with the title of“occupational health”has been on the rise and reached its peak in 2014. China Occupational Medicine，Chinese Journal of Industrial Hygiene and Occupational Diseases，and Chinese Journal of Industrial Medicine were the top three journals in terms of number of articles published，which produced 438，339 and 280 articles respectively. Chinese Center for Disease Control and Prevention and Guangdong Province Hospital for Occupational Disease Prevention and Treatment were the top two organizations in terms of number of articles published，which produced 169 and 116 articles respectively. Occupational medical examination，occupational health surveillance，and occupational health risk assessment were the three hot issues in the field of occupational health research. Conclusions In the past 30 years， occupational health research in China has achieved remarkable progress in terms of article publications and interdisciplinary cooperation，and future work should focus on the academic impact of articles and interdisciplinary research cooperation.

Analysis of the quality control of occupational medical examination in Guangdong Province in 2021 / 中国职业医学

@#Abstract: Objective To analyze the quality control of occupational medical examination (OME) in Guangdong Province. Methods A total of 100 OME institutions in Guangdong Province were selected as the research subjects using the random - Results number table method in 2021. On site quality inspections were carried out and the quality control were analyzed. The - OME institutions that participated in the on site quality inspection in 2021 accounted for 47.4% (100/211) of total OME institutions in Guangdong Province. Among them, occupational disease prevention and control hospitals/institutions and centers for disease control and prevention, public hospitals, and private institutions accounted for 6.0%, 62.0% and 32.0%, respectively. - These institutions distributed in 18 prefecture level cities. The filing categories from high to low were physical factors, chemical factors, dust exposure, other categories (special operations, et al.) and outdoor OME, that accounts for 88.0%, 83.0%, 81.0%, 59.0% and 1.0%, respectively. Most of the institutions recorded three or four categories of OME, accounting for 77.0%. A total of 897 rectification items were detected in the 100 OME institutions, with an average of nine items per institution. The rectification items of the six assessment modules from high to low were quality management work, information report, equipment (instruments and vehicles) configuration, quality management system, medical and health technical personnel configuration, and - on site professional assessment module, accounting for 32.0%, 25.8%, 18.1%, 17.6%, 5.1% and 1.3%, respectively. The - unqualified rate of on site assessment of professional technicians from high to low were technical director, quality control - director, pulmonary function operation, audiogram analysis, X ray or digital radiography chest film reading, and the chief ， examiner accounting for 5.0%, 4.0%, 3.3%, 2.5%, 2.5% and 1.0%, respectively. A total of three private institutions aresuspected of violating laws and regulations, The institutions that carry out filing, partial filing and no filing of corresponding OME Conclusion categories were 68.0%, 30.0% and 2.0%, respectively. The OME institutions in Guangdong Province have prominent problems in quality management and information report work. The ability of technical director and quality control director is relatively weak. Emphasis should be placed on the suspected illegal acts of private institutions.

A prevalence study of chronic hepatitis B infection among Filipino seafarers at Seamens’ Hospital Manila

Background@#Chronic hepatitis B infection is endemic in the Philippines, where there is a large population of seafarers, a group considered high risk for HBV infection. As such, epidemiological data on this population group is vital for the targeted approach on health- related policies.@*Objective@#To establish the prevalence of chronic hepatitis B infection among seafarers who underwent pre-employment medical examination (PEME) at Association of Maritime Officers and Seafarers’ Union of the Philippines-Seamen’s Hospital (AMOSUP-SH) from 2013-2017.@*Methods@#3696 charts were included for review. Charts with positive HbsAg results were sorted, counted, and analyzed. Subsequent data extraction was done on age, sex, marital status, religion, position on board, history of STD and prior surgeries, presence of tattoos, and the result of HIV and syphilis serology test. These were then described using frequency and percentage.@*Results@#4.17% (n=154) were HbsAg positive. All were male with a mean age of 44 years old. Majority were married (134, 87%), catholic (149, 96.7%) and on deck position (84, 54.5%). 29.8% had identifiable risk factors and these were surgical history (37, 24.03%) and body tattoos (11, 7.14%) while none had a history of STD and a positive test for HIV and syphilis.@*Conclusions@#The level of HBsAg seroprevalence among Filipino seafarer is at the low intermediate level of endemicity.

Exame ocupacional periódico: oportunidade de diagnóstico e monitoramento de doença crônica não transmissível em homens / Periodic occupational examination: an opportunity for diagnosis and monitoring of chronic noncommunicable diseases in men / Examen ocupacional periódico: oportunidad de diagnóstico y supervisión de enfermedad crónica no transmisible en hombres

Objetivou-se estimar a prevalência de hipertensão arterial, como principal marcador de doença crônica não transmissível (DCNT), e identificar os fatores modificáveis associados, em trabalhadores homens. Foram utilizados dados da linha de base de um estudo longitudinal com uma amostra de 1.024 trabalhadores homens com 18 anos ou mais de um município do Nordeste do Brasil. O marcador de DCNT foi a hipertensão arterial, definida por pressão arterial sistólica ≥ 140mmHg e/ou pressão arterial diastólica ≥ 90mmHg e/ou diagnóstico prévio de hipertensão arterial e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Foram calculadas frações atribuíveis populacionais (FAP) para as variáveis de estilo de vida, a fim de dimensionar o impacto dos fatores modificáveis na saúde dos trabalhadores. A prevalência da hipertensão arterial nesta população foi de 28,6% (IC95%: 25,9-31,5), os fatores distais: idade > 40 anos, cor da pele preta e renda familiar ≥ 3 salários mínimos; fatores intermediários: consumo abusivo de álcool, consumo de tabaco, percepção de um consumo elevado de sal e inatividade física e o fator proximal: sobrepeso e obesidade associaram-se positivamente com a hipertensão arterial. O cálculo da FAP permitiu observar que se ocorresse a redução ou eliminação de hábitos e comportamentos relacionados ao estilo de vida deste público, reduziria em 56,1% a prevalência da DCNT estudada. A identificação de fatores modificáveis e como estes podem interferir negativamente na saúde de trabalhadores homens possibilita o planejamento de intervenções no próprio local de trabalho, a fim de alcançar o maior número de indivíduos, visando reduzir os efeitos deletérios das DCNT.

The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs.

El objetivo fue estimar la prevalencia de hipertensão arterial, como principal marcador de enfermedad crónica no transmisible (ECNT), así como identificar factores modificables asociados, en hombres trabajadores. Se utilizaron datos de la línea de base, procedentes de un estudio longitudinal, con una muestra de 1.024 hombres trabajadores con 18 años o más de un municipio del Nordeste de Brasil. El marcador de ECNT fue la hipertensão arterial, definida por presión arterial sistólica ≥ 140mmHg y/o presión arterial diastólica ≥ 90mmHg y/o diagnóstico previo de hipertensão arterial y/o uso de medicamentos antihipertensivos. Se empleó la regresión de Poisson con varianza robusta, adoptando la entrada jerárquica de variables. Se calcularon fracciones atribuibles poblacionales (FAP) en las variables de estilo de vida, a fin de dimensionar el impacto de los factores modificables en la salud de los trabajadores. La prevalencia de la hipertensão arterial en esta población fue de 28,6% (IC95%: 25,9-31,5), los factores distales: edad > 40 años, color de piel negra y renta familiar ≥ 3 salarios mínimos; factores intermedios: consumo abusivo de alcohol, consumo de tabaco, percepción de un consumo elevado de sal e inactividad física y el factor proximal: sobrepeso y obesidad se asociaron positivamente con la hipertensão arterial. El cálculo de la FAP permitió observar que, si se produjese una reducción o eliminación de hábitos y comportamientos relacionados con el estilo de vida de este público, se reduciría en un 56,1% la prevalencia de la ECNT estudiada. La identificación de factores modificables y cómo pueden interferir negativamente en la salud de hombres trabajadores posibilita la planificación de intervenciones en el propio lugar de trabajo, con el fin de alcanzar al mayor número de individuos para reducir los efectos mortíferos de las ECNT.

Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned / Solicitação inapropriada de marcadores tumorais em pacientes com 50 anos ou mais: lições não aprendidas

OBJECTIVE: To investigate, within a private health insurance, the ordering frequency and the costs related to inappropriate tumor markers test orders. METHODS: This study analyzed data regarding tumor markers requests within a private health insurance between 2010 and 2017. Patients included in this analysis were ≥ 50 years old, had available medical records, and had at least 1 tumor markers tested within the study period. Tests were considered inappropriate when tumor markers were used in screening for neoplasms, ie, when there was no previous diagnosis. We evaluated data regarding age, sex, the ordering physician's medical specialty, and test costs. RESULTS: Between 2010 and 2017, 1112 tumor markers tests were performed and increased from 52 to 262 per year. Our sample consisted mostly of women (69.50%) with a mean age of 59.40 (SD 8.20) years. Most orders were inappropriate (87.80%) and represented 79.40% of all expenses with tumor markers tests. Cardiology professionals were the medical specialty that requested the most tumor markers tests (23.90%), followed by internal medicine specialists (22.70%) and gynecologists (19.20%). CONCLUSIONS: We observed a high percentage of inappropriate test orders in the study period, resulting in elevated costs. Studies of this nature deserve the attention of health care managers, and interventions should be performed in order to reduce the inappropriate use of tumor markers tests in clinical practice.

OBJETIVO: investigar no âmbito de um plano de saúde privado a frequência de solicitação e os custos relacionados à solicitação inapropriada de marcadores tumorais. METODOLOGIA: Utilizou-se a base de dados de um plano de saúde privado entre os anos de 2010 a 2017. Foram incluídos na pesquisa, sujeitos com idade ≥ 50 anos, que apresentavam prontuários médicos acessíveis e que havia realizado a dosagem de algum marcadores tumorais no período. Considerou-se como "exame inapropriado" quando o marcador tumoral foi utilizado como rastreio de neoplasia, ou seja, quando não havia o diagnóstico prévio. Foram avaliados os dados referentes à idade, sexo, especialidade do médico solicitante e informações sobre os custos desses exames. RESULTADOS: Foram realizados um total 1.112 testes no período, representando um aumento de 52 para 262 exames/ano. A amostra foi composta na maioria pelo sexo feminino (69,50%), com média de idade de 59,40 ± 8,20 anos. A maioria das solicitações foram inapropriadas (87,80%). Notou-se que a solicitação desses exames, impactaram cerca de 79,40% dos gastos totais do plano de saúde com marcadores tumorais. Os cardiologistas foram a especialidade que mais solicitaram marcadores tumorais em 23,90% das ocasiões, seguidos pelos especialistas em clínica médica (22,70%) e ginecologistas (19,20%). CONCLUSÕES: Observamos um alto percentual de pedidos de exames inadequados no período do estudo, resultando em custos elevados. Estudos dessa natureza merecem a atenção dos gestores de saúde e intervenções devem ser realizadas a fim de reduzir o uso inadequado de testes de marcador tumoral na prática clínica.

Descripción del abuso sexual pediátrico a partir de hallazgos del examen físico / Description of pediatric sexual abuse based on physical exam findings

La comprensión de la frecuencia y el significado de diversos hallazgos médicos en niños sometidos a abuso sexual se modificaron con el tiempo. Antes de 1989, se pensaba que diversas variaciones en la apariencia de los tejidos genitales y anales se debían al abuso. Los estudios que describen en detalle la apariencia de los tejidos anales en niños seleccionados como no sometidos a abuso en 1989 y los hallazgos genitales en niñas no sometidas a abuso en 1990, mostraron que muchas de estas variaciones también se observaron en niños que no habían experimentado abuso. Las más comunes de estas variaciones se incluyeron en una lista de hallazgos anogenitales que también comprendían signos conocidos de lesiones agudas e infecciones de transmisión sexual, así como otros hallazgos físicos y de laboratorio cuya importancia con respecto al abuso se desconocía. Esta lista evolucionó a medida que se publicaban nuevos estudios y se procuraba llegar a un consenso entre los expertos en la evaluación del abuso sexual en niños en cuanto a la forma en que debían interpretarse los hallazgos de los exámenes médicos adicionales. La tabla de "interpretación de los resultados" evolucionó durante los 26 años siguientes, y la más reciente se publicó en 2018. Todavía hay hallazgos, en junio de 2020, respecto de los cuales no hay consenso entre los expertos en cuanto a cómo deben interpretarse en un niño evaluado por presunción de abuso sexual. Deberán revisarse los antecedentes de los cambios en la interpretación de los hallazgos genitales y perianales en niños con presunción de abuso sexual.

The understanding of the frequency and significance of various medical findings in sexually abused children has changed over time. Before 1989, several variations in the appearance of genital and anal tissues were thought to be due to abuse. Studies describing in detail the appearance of anal tissues in children selected for non-abuse in 1989, and genital findings in non-abused girls in 1990, showed that many of these variations were seen non-abused children as well. The most common of these variations were included in a listing of anogenital findings that also included known signs of acute injury and sexually transmitted infections, as well as other physical and laboratory findings for which the significance with respect to abuse was unknown. This listing evolved as new studies were published and efforts were made to reach consensus among experts in child sexual abuse evaluation as to how additional medical examination findings should be interpreted. The "Interpretation of Findings" table evolved over the next 26 years, with the most recent being published in 2018. There are still findings, as of June, 2020, for which no expert consensus exists as to how they should be interpreted in a child who is being evaluated for suspected sexual abuse. The history of the changes in the interpretation of genital and perianal findings in children with suspected sexual abuse will be reviewed.

Imagem Cardiovascular e Procedimentos Intervencionistas em Pacientes com Infecção pelo Novo Coronavírus / Cardiovascular Imaging and Interventional Procedures in Patients with Novel Coronavirus Infection

Resumo A pandemia da doença causada pelo novo coronavírus (COVID-19) trouxe grandes desafios para o sistema de saúde devido ao aumento exponencial do número de pacientes acometidos. A racionalização de recursos e a indicação correta e criteriosa de exames de imagem e procedimentos intervencionistas tornaram-se necessárias, priorizando a segurança do paciente, do ambiente e dos profissionais da saúde. Esta revisão visa auxiliar e orientar os profissionais envolvidos na realização desses exames e procedimentos a fazê-los de forma eficaz e segura.

Abstract The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures.