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Background Regular physical examination contributes to early detection and timely treatment, which is helpful in promoting healthy behaviors and preventing diseases. The objective of this study is to compare the annual physical examination (APE) use between rural and urban elderly in China. Methods A total of 3,922 participants (60+) were randomly selected from three urban districts and three rural counties in Shandong Province, China, and were interviewed using a standardized questionnaire. We performed unadjusted and adjusted logistic regression models to examine the difference in the utilization of APE between rural and urban elderly. Two adjusted logistic regression models were employed to identify the factors associated with APE use in rural and urban seniors respectively. Results The utilization rates of APE in rural and urban elderly are 37.4% and 76.2% respectively. Factors including education level, exercise, watching TV, and number of non-communicable chronic conditions, are associated with APE use both in rural and urban elderly. Hospitalization, self-reported economic status, and health insurance are found to be significant ( p  < 0.05) predictors for APE use in rural elderly. Elderly covered by Urban Resident Basic Medical Insurance (URBMI) ( p  < 0.05, OR = 1.874) are more likely to use APE in urban areas. Conclusions There is a big difference in APE utilization between rural and urban elderly. Interventions targeting identified at-risk subgroups, especially for those rural elderly, are essential to reduce such a gap. To improve health literacy might be helpful to increase the utilization rate of APE among the elderly.

Background In Germany, adult health checks are carried out in the primary care setting for early detection of chronic conditions, such as cardiovascular diseases, diabetes, and kidney disease. This study aims to examine the social, behavioural, and health-related determinants of health check attendance among eligible adults in Germany. Methods Data were derived from the cross-sectional German Health Update (GEDA) study, a national health survey among adults in Germany carried out by the Robert Koch Institute. Analyses were restricted to respondents with statutory health insurance aged 35 years or older (n = 26,555). Logistic regression models were fitted to estimate associations between health check attendance and factors selected on the basis of Andersen’s Behavioral Model of Health Services Use. Results After mutual adjustment, higher health check attendance was associated with a higher age, higher socioeconomic status, being married, stronger social support, physical activity, non-smoking, greater fruit and vegetable consumption, and higher use of outpatient care in both sexes. In women, higher attendance was related to alcohol consumption and having company health insurance (BKK) after multiple adjustment. In men, higher attendance was associated with better self-rated health after adjusting for all other factors. Conclusions The findings of this study suggest that people with an unfavourable risk factor profile, such as socioeconomically disadvantaged groups, smokers, physically inactive people, and persons with a low fruit and vegetable intake, are less likely to have health checks than those with a more favourable risk profile. Health checks carried out in the primary care setting should be evaluated for their effects on population health and health inequality.

Routine breast cancer follow-up aims at detecting second primary breast cancers and loco regional recurrences preclinically. We studied breast cancer follow-up practice and mode of relapse detection during the first 5 years of follow-up to determine the efficiency of the follow-up schedule. The Netherlands Cancer Registry provided data of 6,509 women, operated for invasive non-metastatic breast cancer in 2003–2004. In a random sample including 144 patients, adherence to follow-up guideline recommendations was studied. Mode of relapse detection was studied in 124 patients with a second primary breast cancer and 160 patients with a loco regional recurrence. On average 13 visits were performed during the first 5 years of the follow-up, whereas nine were recommended. With one, two and three medical disciplines involved, the number of visits was 9, 14 and 18, respectively. Seventy-five percent (93/124) of patients with a second primary breast cancer, 42 % (31/74) of patients with a loco regional recurrence after breast conserving surgery and 28 % (24/86) of patients with a loco regional recurrence after mastectomy had no symptoms at detection. To detect one loco regional recurrence or second primary breast cancer preclinically, 1,349 physical examinations versus 262 mammography and/or MRI tests were performed. Follow-up provided by only one discipline may decrease the number of unnecessary follow-up visits. Breast imaging plays a major and physical examination a minor role in the early detection of second primary breast cancers and loco regional recurrences. The yield of physical examination to detect relapses early is low and should therefore be minimised.

Background Breast cancer screening recommendations are in flux. We reviewed the methods of detecting newly diagnosed breast neoplasms at our institution. Methods A retrospective review of patients stratified by age was performed to compare mammography with self- (SBE) and clinical (CBE) breast examination methods of cancer detection from 2005 to 2009. Results We identified 782 patients. Patients aged <50 years were more likely to present with palpable disease ( P  < 0.001). Overall, 75% of patients had a mammogram within 24 months. There was a higher incidence of Tis tumors and lower incidence of T1 tumors if patients had mammography performed within 12 months versus 13–24 months ( P  < 0.01); tumor size, hormonal status, and lymph node (LN) status were comparable between these two groups. Patients diagnosed by SBE/CBE who had mammography performed within 12 months versus 13–24 months did not differ statistically according to tumor characteristics. In the screened cohort (mammography within 24 months), the majority of patients (64%) were diagnosed by mammography. Cancers detected by SBE/CBE were larger tumors (2.4 vs. 1.3 cm), higher grade, more frequently ER- (29 vs. 16%), triple-negative (21 vs. 10%), and lymph node-positive (39 vs. 18%; all P  ≤ 0.01). There were no statistically significant differences in tumor size, T stage, or hormonal status in patients who had analog versus digital mammography. Conclusions Whereas the majority of patients had image-detected breast cancer, a significant number of image-screened patients presented with palpable disease, which were more aggressive cancers. Until imaging techniques are refined, SBE and CBE remain important for breast cancer diagnosis.

Background Periodic physical examination is considered helpful in preventing illness and promoting health among the elderly. Limited information is available about the use of annual physical examinations among the elderly in rural areas, however. This research explores the distribution characteristics of annual physical examination use and its determinants among people aged 60 or over in rural China. Methods A cross-sectional study was undertaken to estimate distribution characteristics of annual physical examination use and to collect data of sociodemographic characteristics, health knowledge level, and health communication channels. Participants were 1128 people aged 60 or over, randomly selected from four different provinces in the East, Mid-East, Mid-West, and West China. Logistic regression determined the predictors of annual physical examination use. Results Participants were predominantly aged 60–79 (44.1%) and 70–79 (42.0%). A total of 716 (63.5%) participants underwent annual physical examinations. Those who reported acquiring health knowledge via bulletin boards and village doctors had a higher probability of using annual physical examinations (OR = 3.15 and 1.53). The probability for civil servants/retired having annual physical examinations was 2.16 times higher than for farmers. Those who had an average level of health knowledge had a higher probability of using annual physical examinations than those at the below-average level (odds ratio: 2.07). Conclusion The government and public health institutions should assist farmers to acquire the habit of having annual physical examinations. Traditional channels, such as bulletin boards, should be used to deliver health information. Village doctors should be supported in delivering health information to the elderly in rural areas.

Technology advances make it possible to consider continuous acoustic respiratory rate monitoring as an integral component of physiologic surveillance systems. This study explores technical and logistical aspects of augmenting pulse oximetry-based patient surveillance systems with continuous respiratory rate monitoring and offers some insight into the impact on patient deterioration detection that may result. Acoustic respiratory rate sensors were introduced to a general care pulse oximetry-based surveillance system with respiratory rate alarms deactivated. Simulation was used after 4324 patient days to determine appropriate alarm thresholds for respiratory rate, which were then activated. Data were collected for an additional 4382 patient days. Physiologic parameters, alarm data, sensor utilization and patient/staff feedback were collected throughout the study and analyzed. No notable technical or workflow issues were observed. Sensor utilization was 57 %, with patient refusal leading reasons for nonuse (22.7 %). With respiratory rate alarm thresholds set to 6 and 40 breaths/min., the majority of nurse pager clinical notifications were triggered by low oxygen saturation values (43 %), followed by low respiratory rate values (21 %) and low pulse rate values (13 %). Mean respiratory rate collected was 16.6 ± 3.8 breaths/min. The vast majority (82 %) of low oxygen saturation states coincided with normal respiration rates of 12–20 breaths/min. Continuous respiratory rate monitoring can be successfully added to a pulse oximetry-based surveillance system without significant technical, logistical or workflow issues and is moderately well-tolerated by patients. Respiratory rate sensor alarms did not significantly impact overall system alarm burden. Respiratory rate and oxygen saturation distributions suggest adding continuous respiratory rate monitoring to a pulse oximetry-based surveillance system may not significantly improve patient deterioration detection.

We sought to clarify the association between the personal utilization of general health checkups (GHCs) and medical expenditures (MEs) in a middle-aged Japanese population. A retrospective cohort study was conducted. Subjects were 33,417 residents (15,819 males and 17,598 females) aged 48 years or older in 2010 who were invited to undergo GHCs every year. Official records on GHCs from 2002 to 2007 and MEs from 2008 to 2010 were provided by Soka City, Saitama Prefecture, Japan. The utilization of GHCs was divided into zero times (non-utilizers), 1–3 times (low-frequency utilizers), and 4–6 times (high-frequency utilizers). Tweedie distributions in the generalized linear model were used to analyze the association between MEs and the subgroups of GHC utilization after adjustment for age and sex. Of the 33,417 subjects, 20,578 (61.6%) were non-utilizers, 5,777 (17.3%) were low-frequency utilizers, and 7,062 (21.1%) were high-frequency utilizers, based on the attendance to GHCs from 2002 to 2007. Compared with the non-utilizers, the high-frequency utilizers showed significantly higher outpatient MEs (JPY394,700 vs. JPY373,100). The low- and high-frequency utilizers showed significantly lower inpatient MEs (JPY224,000 and JPY181,500 vs. JPY309,300) and total MEs (JPY610,600 and JPY580,700 vs. JPY689,600) than the non-utilizers based on the pooled data from 2008 to 2010. This study suggests that the outpatient MEs rise when annual GHCs are increasingly attended (not including the GHC cost), but inpatient and total MEs are lower. To reduce MEs, increasing the rates of attendance at GHCs by the general public may be important. •To clarify the association between General Health Checkups and Medical Expenditures.•A retrospective cohort study was conducted in a middle-aged Japanese population.•Non-, low-, and high-frequency utilizers were divided based on the 6-year GHCs.•3-year MEs were analyzed using Tweedie distribution for a generalized linear model.•Outpatient MEs rise when GHCs are frequent, but inpatient and total MEs are lower.

Background Preventive health check-ups in Austria are offered free of charge to all insured adults (98% of the population) and focus on early detection of chronic diseases, primary prevention, and health counseling. The study aims to explore predictors of compliance with the recommended interval of preventive health check-up performance. Methods Source of data was the Austrian Health Interview Survey 2006/07 (15,474 subjects). Participation in a preventive health examination during the last three years was used as dependent variable. Socio-demographic and health-related characteristics were used as independent variables in a multivariate logistic regression analysis. Results Results show that 41.6% of men and 41.8% of women had attended a preventive health check-up within the last three years. In multivariate analysis, subjects ≥40 years, with higher education, higher income or born in Austria were significantly more likely to attend a preventive health check-up. Furthermore, a chronic disease was associated with a higher attendance rate (OR: 1.21; CI: 1.07-1.36 in men; OR: 1.19; CI: 1.06-1.33 in women). Conclusions Attendance rates for health check-ups in the general Austrian population are comparatively high but not equally distributed among subgroups. Health check-ups must increase among people at a young age, with a lower socio-economic status, migration background and in good health.

Health services for victims of rape are recognised as a particularly neglected area of the health sector internationally. Efforts to strengthen these services need to be guided by clinical research. Expert medical evidence is widely used in rape cases, but its contribution to the progress of legal cases is unclear. Only three studies have found an association between documented bodily injuries and convictions in rape cases. This article aims to describe the processing of rape cases by South African police and courts, and the association between documented injuries and DNA and case progression through the criminal justice system. We analysed a provincially representative sample of 2,068 attempted and completed rape cases reported to 70 randomly selected Gauteng province police stations in 2003. Data sheets were completed from the police dockets and available medical examination forms were copied. 1,547 cases of rape had medical examinations and available forms and were analysed, which was at least 85% of the proportion of the sample having a medical examination. We present logistic regression models of the association between whether a trial started and whether the accused was found guilty and the medico-legal findings for adult and child rapes. Half the suspects were arrested (n = 771), 14% (209) of cases went to trial, and in 3% (31) of adults and 7% (44) of children there was a conviction. A report on DNA was available in 1.4% (22) of cases, but the presence or absence of injuries were documented in all cases. Documented injuries were not associated with arrest, but they were associated with children's cases (but not adult's) going to trial (adjusted odds ratio [AOR] for having genital and nongenital injuries 5.83, 95% confidence interval [CI] 1.87-18.13, p = 0.003). In adult cases a conviction was more likely if there were documented injuries, whether nongenital injuries alone AOR 6.25 (95% CI 1.14-34.3, p = 0.036), ano-genital injuries alone (AOR 7.00, 95% CI 1.44-33.9, p = 0.017), or both nongenital and ano-genital injuries (AOR 12.34, 95% CI 2.87-53.0, p = 0.001). DNA was not associated with case outcome. This is the first study, to our knowledge, to show an association between documentation of ano-genital injuries, trials commencing, and convictions in rape cases in a developing country. Its findings are of particular importance because they show the value of good basic medical practices in documentation of injuries, rather than more expensive DNA evidence, in assisting courts in rape cases. Health care providers need training to provide high quality health care responses after rape, but we have shown that the core elements of the medico-legal response require very little technology. As such they should be replicable in low- and middle-income country settings. Our findings raise important questions about the value of evidence that requires the use of forensic laboratories at a population level in countries like South Africa that have substantial inefficiencies in their police services. Please see later in the article for the Editors' Summary.