martes, 10 de noviembre de 2015

EL NUEVO ESCANDALO DE DOPAJE. ACTIVIDAD EVALUADA

ACTIVIDAD:

Leer la transcripción de los dos artículos publicados en el periódico The New York Times, e ir a los enlaces relacionados, y hacer un análisis de su contenido utilizando sus conocimientos del idioma Inglés y de sus dos unidades curriculares como ejes transversales de la carrera Ciencias del Deporte. Luego desarrollar un ensayo en Español de máximo 4 páginas en Word, fuente times new roman tamaño 12, tamaño carta, con portada y conclusiones, para ser entregado vía correo electrónico a lacabrabicicletera@yahoo.com el jueves 19 de noviembre.


Years Later, Bittersweet Victory for Alysia Montaño
By CHRISTOPHER CLAREYNOV. 9, 2015 



Alysia Montaño was fifth in the women’s 800 at the 2012 Olympics. A World Anti-Doping Agency report has detailed doping in Russian track and field. Credit Josh Haner/The New York Times
Alysia Montaño, an American 800-meter runner, woke up early in Valencia, Calif. Knowing the World Anti-Doping Agency was releasing the findings of its extraordinary inquiry into doping and corruption in Russian track and field, she devoured the details of the report in bed as soon as she awoke.
And then she began to cry.
“My hands were shaking,” she said by telephone on Monday. “Anger, sadness, relief, all of it. I just got a rush of emotions. I can’t even pinpoint all of them. At first you think of all the moments you lost, and then you feel, ‘Oh my gosh, well, thank you.’ Then you are mad. I was sweating. I just broke out in a sweat, thinking, Is this real? Are they actually going to do something?”
The answer at this deeply demoralizing point for track and field appears to be yes, and it must be yes after all the institutional rot that Dick Pound’s committee confirmed and exposed in its 323-page report. Cover-ups of positive tests. Extortion. More than 1,400 destroyed samples. It is no wonder Pound’s independent committee has recommended Russia be suspended from track and field competition, including next year’s Olympics in Rio de Janeiro, until it proves it can play and test fair.

Mariya Savinova winning the women’s 800 at the London Games. Alysia Montaño is at far left. Credit Josh Haner/The New York Times
But for Pound to say he was surprised was quite an admission, considering that he was part of the Canadian delegation when the 100-meter champion Ben Johnson tested positive at the 1988 Olympics and later led the International Olympic Committee investigation into the Salt Lake City corruption scandal.
Montaño, still competing at age 29 after giving birth to a daughter last year, agrees with the push to ban Russia. She also believes she deserves some medals after finishing fourth in the 800 meters at the 2011 world championships, fifth in the 2012 London Olympics and fourth again at the 2013 world championships. In all those cases, she finished behind Russians who now face lifetime bans from the sport.
“Absolutely I deserve that bronze medal,” Montaño said of her Olympic race. “Even if I don’t get my podium moment, it’s still a symbol of my work and also this time in history.”
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Montaño said she was convinced her Russian rivals were doping in London, and the WADA report concluded as much. It called Russia’s inaction on expeditiously dealing with flags in the biological passports of Mariya Savinova, who won the gold, and Ekaterina Poistogova, who took the bronze, “unexplained and highly suspicious.”
“When you go back and watch the race,” Montaño said, “and you see someone literally watching the race behind you, kind of jogging, and you are putting out max effort, and they kind of just walk past you, put their hands in the air and are like ‘Yay!’ and you are on the ground, huffing and puffing and about to throw up, you are like, ‘Are you kidding me?’ But you can’t speak up until you have evidence. You just come off as a sour apple.”



But missing the podium in London cost her more than sleep. It cost her money. “Maybe half a million dollars, if you look at rollovers and bonuses, and that’s without outside sponsorship maybe coming in,” she said. “That’s not why you’re doing it, but you still deserve it.”
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There have been too many dark times in her sport’s history, too many high-profile busts that should have solved the major doping problem for good but turned into false dawns: Johnson in 1988, or the American sprinter Marion Jones and the Bay Area Laboratory Co-operative in the 2000s.
You can say this for track and field: It takes down its biggest stars. The trouble is that outside prodding and enterprise are too often required. “Obviously, it’s sad that it took a big investigative report for them to do something,” Montaño said, praising — as Pound had — a groundbreaking German television documentary by ARD that brought the Russian doping to light last year.
But what makes this round of scandal more egregious is the degree of cynicism and venality. If it is proved that Lamine Diack, who served for 16 years as president of track and field’s governing body, the International Association of Athletics Federations, did indeed demand bribes totaling more than one million euros in order to suppress positive doping tests, then the corruption went straight from the top to the track. And what would make it all the more unforgivable is that Diack spent much of his mandate defending his federation’s record on antidoping, most recently when he commandeered the microphone to make a rambling, closing remark on the subject at his farewell news conference in Beijing in August.
The French authorities, who have placed Diack under criminal investigation on suspicion of corruption and money laundering, will have the final word on his involvement. But Montaño does not sound nearly as surprised as one would expect her to be.
“I try not to think about the most negative thing, but when I heard it, I thought that sounds about right,” she said. “The I.A.A.F. is a corrupt organization. So this says everything anyone has ever assumed, if you want to use the word assumed. But it’s the truth. You can’t assume the truth.”
The question now — with the latest hurricane over and the beach covered with broken trust and debris — is how the I.A.A.F. and Russia will clean up. It seems imperative that WADA’s leadership heed the Pound committee recommendation and declare Russia noncompliant with the WADA code at its board meeting next week. It seems imperative that the I.A.A.F. act with equal alacrity to ban Russia from track and field competitions.
Sebastian Coe, who succeeded Diack as I.A.A.F. president in August, already is facing calls to step down. Coe was vice president of the I.A.A.F. for eight years before securing the top spot, and he spent many an hour in Diack’s company without — so Coe insists — the slightest inkling of Diack’s suspected criminal behavior.
“I will do whatever it will take to fix this,” Coe told Britain’s Channel 4 on Monday. “I have the full support of the sport, and I will do this.”
It is tempting, very tempting, to conclude once and for all that international sports federations have no business testing and sanctioning their own athletes, their own meal tickets. Even in a best case, the appearance of conflict still exists.
Giving a more neutral organization like WADA full responsibility for testing international-level athletes is one solution. The shift could be financed by pooling existing antidoping resources and by increasing the money supplied by the I.O.C. and national governments. But that tack, too, carries a risk. Who then monitors WADA?
“I think we need to look at an outside doping agency, people that aren’t related to the sport,” Montaño said. “We need someone who is a biochemist and all they are into is the lab report.”
Whatever the changes, they will come too late for Montaño to get her rightful Olympic moment or reward. She still has lofty goals, however.
“I’d really like to race,” she said, “in the women’s human 800-meter clean athletes final.”
A version of this article appears in print on November 10, 2015, on page B10 of the New York edition with the headline: Years Later, Bittersweet


Drugs Pervade Sport in Russia, World Anti-Doping Agency Report Finds



Dick Pound arrived to speak at a news conference in Geneva on Monday. Credit Salvatore Di Nolfi/Keystone, via Associated Press
GENEVA — Members of Russia’s secret service intimidated workers at a drug-testing lab to cover up top athletes’ positive results. They impersonated lab engineers during the Winter Olympics in Sochi last year. A lab once destroyed more than 1,400 samples.
Athletes adopted false identities to avoid unexpected testing. Some paid to make doping violations disappear. Others bribed the antidoping authorities to ensure favorable results, and top sports officials routinely submitted bogus urine samples for athletes who were doping.
Those allegations were among hundreds contained in a report released Monday by the World Anti-Doping Agency. Across 323 pages, it implicates athletes, coaches, trainers, doctors and various Russian institutions, laying out what is very likely the most extensive state-sponsored doping program since the notorious East German regime of the 1970s.
In addition to providing a granular look at systematic doping, the group that drafted the report made extraordinary recommendations, including a proposal that Russia be suspended from competition by track and field’s governing body and barred from track and field events at next summer’s Olympics in Rio de Janeiro.

 “It’s worse than we thought,” Dick Pound, founding president of the World Anti-Doping Association and an author of the report, said at a news conference in a Geneva hotel. “This is an old attitude from the Cold War days.”
Russian officials responded with defiance, disputing the investigation’s findings. “Whatever we do, everything is bad,” Vitaly Mutko, Russia’s sports minister, told the news agency Interfax. “If this whole system needs to shut down, we will shut it down gladly. We will stop paying fees, stop funding the Russian antidoping agency, the Moscow antidoping laboratory. We will only save money.”
Dr. Grigory Rodchenkov, the director of the Moscow lab whom Monday’s report accused of having solicited and accepted bribes, dismissed the suggestions. “This is an independent commission which only issues recommendations,” he said. “There are three fools sitting there who don’t understand the laboratory.”
Mr. Pound said he had presented the group’s findings to Mr. Mutko before they were released publicly. “He’s frustrated to some degree,” he said. “He certainly knew what was going on. They all knew.”
The report also recommended that the World Anti-Doping Agency impose lifetime bans on five Russian coaches and five athletes, including the gold and bronze medalists in the women’s 800 meters at the 2012 London Olympics.
“The Olympic Games in London were, in a sense, sabotaged by the admission of athletes who should have not been competing,” the report read.
Bans from competition are not all that could come of the inquiry. Mr. Pound said the agency had negotiated a cooperation agreement with Interpol and had handed over extensive documents and evidence. Interpol confirmed that cooperation with its own announcement on Monday, noting that related inquiries stretched from Singapore to France.

Russia Is the Violations Leader 

 

In June 2015, the World Anti-Doping Agency released its first set of statistics on doping violations. The violations, taken from 2013 data, included 115 countries and 89 sports. Russia had the highest number of violations -- 225 across 30 sports -- with 42 of them coming from track and field events.
Last week, the French authorities announced that they had opened a criminal investigation into the former president of track and field’s world governing body, Lamine Diack of Senegal, over allegations that he accepted bribes to allow at least six Russian athletes to participate in competitions, including the 2012 Olympics.
The former director of the medical and antidoping division of that governing body, the International Association of Athletics Federations, is also under investigation, the French authorities said, along with Mr. Diack’s legal adviser.
Russian athletes, in soaring numbers, have been caught doping in recent years. Russia had far more drug violations than any other country in 2013 — 225, or 12 percent of all violations globally, according to data from the World Anti-Doping Agency. About a fifth of Russia’s infractions involved track and field athletes, the focus of Monday’s report.
“This level of corruption attacks sport at its core,” Richard H. McLaren, a Canadian lawyer and an author of the report, said in an interview Sunday. In contrast to corporate governance scandals like those currently affecting world soccer, he said, drug use by athletes has distorted the essence of professional games. “Bribes and payoffs don’t change actual sporting events,” Mr. McLaren said. “But doping takes away fair competition.”
The report released Monday was the result of a 10-month investigation by an independent commission of WADA. Its inquiry stemmed from a December 2014 documentary by the German public broadcaster ARD, which drew on accounts from Russian athletes, coaches and antidoping officials, who said that the Russian government had helped procure drugs for athletes and cover up positive test results.
Further allegations emerged in August, when ARD and The Sunday Times of London released another report more broadly covering the leaked results of thousands of international athletes’ blood tests dating to 2001, showing decorated athletes in good standing with suspicious drug tests. Those allegations — which drew significant suspicion to Kenya — are also being investigated by the independent commission, but the results were not included in Monday’s report, as the inquiry is not complete, the agency said.
The three-person commission, led by Mr. Pound, also included Mr. McLaren, who teaches law at the University of Western Ontario, and Günter Younger, the head of cybercrime for the police in the German state of Bavaria.

Commission Accuses Russia of Doping

Richard W. Pound, a co-author of a report from the World Anti-Doping Agency accusing Russia of running a doping program, spoke on Monday in Geneva on the findings.
WADA’s foundation and executive board will decide whether to act on the commission’s recommendations; they are scheduled to meet next week in Colorado Springs, an event that motivated the timing of the release of the commission’s report, Mr. Pound said.
In a statement on Monday, the International Olympic Committee called the report “deeply shocking” and said it trusted the judgment of the I.A.A.F., which would decide whether to bar Russia from competition.
Mr. Pound did not offer any time frame for the recommended suspension. If Russia did not fight the prescriptions — to enact rigorous and specific drug-testing controls — he said he thought it could be possible for the country’s track and field athletes to compete in the Summer Olympics.
 “If they do the surgery and do the therapy, I hope they can get there,” he said. “That is your nuclear weapon. Either get this done or you are not going to Rio.”
The commission also recommended that the Russian antidoping authority be declared non-code-compliant indefinitely; that the director of the Moscow laboratory be removed from his job; and that the lab, which was provisionally banned in 2013, lose its accreditation.
In the case of financial prizes awarded to athletes with drug test results now thought to be tainted, “the money’s gone,” Mr. Pound said, “and whoever ought to have won didn’t.”
The Russian Ministry of Sport did not immediately respond to a request for comment. But the initial reaction in Russia fell in line with the tradition since Soviet times, with many attributing the revelations to a Western plot to undermine the country’s accomplishments.

“It is all connected with the fact that Russian athletes demonstrate such good results, some countries are not satisfied with it,” said Igor Ananskikh, a member of the youth policy and sports committee of the Russian Parliament.
Nikolai Valuev, a former Russian heavyweight boxing champion now serving as a deputy in the Parliament, said on the state-run Rossiya 24 television channel: “In recent times, I hear only about investigations of Russian athletes. This has already become a system, too.
“First of all,” he said, “we must conduct a broad investigation to find out whether the results of the investigation are true.”
Days before Monday’s report was published, however, Russia’s athletics federation suspended five athletes, including a noted distance runner, Maria Konovalova.
“The Russians themselves have said there are vestiges of the old Soviet system, old-guard coaches who haven’t changed and can’t change,” Mr. McLaren said. “The minister of sport says their way of operating is over. But read our report.”
Russia has had a particularly prominent place in the international sports spotlight in recent years, hosting not only the Winter Games in Sochi in 2014 but also the track and field world championships in Moscow the year before.
The country is scheduled to host the next World Cup, in 2018, although the Swiss authorities are investigating allegations that Russia might have secured the tournament through under-the-table agreements. The Moscow laboratory implicated in Monday’s report is set to oversee testing for FIFA during the World Cup. The lab did not immediately respond to a request for comment.
Mr. Pound declined to say whether he thought Russia should be stripped of its status as host of that tournament. “I think FIFA’s got to sort out its own difficulties — without our help,” he said.
Mr. Mutko, Russia’s sports minister, sits on FIFA’s executive committee.
“The credibility of sport has taken some serious body blows in the last month,” Mr. Pound said, referring to the FIFA corruption case and to Monday’s report, which suggested that similar doping violations existed beyond track and field. “Public opinion is going to move toward all sports being corrupt.”
Neil MacFarquhar, Ivan Nechepurenko and Alexandra Odynova contributed reporting from Moscow.
A version of this article appears in print on November 10, 2015, on page A1 of the New York edition with the headline: Drugs Pervade Russian Sport, Report Alleges



EL DOPAJE CON NUEVO ESCANDALO.

AGENCIA MUNDIAL ANTI DOPING (AMA o WADA) PUBLICA INFORME QUE SACUDE LOS CIMIENTOS DEL ATLETISMO MUNDIAL, DE LA FEDERACION RUSA DE ATLETISMO Y DEL DEPORTE EN GENERAL.



http://www.nytimes.com/2015/11/10/sports/olympics/years-later-bittersweet-victory-for-alysia-montano.html?ref=sports

 http://www.nytimes.com/2015/11/10/sports/russian-athletes-part-of-state-sponsored-doping-program-report-finds.html?ref=sports

Revisar información de The New York Times en las url anteriores.

miércoles, 21 de octubre de 2015

EL EXAMEN MEDICO DEL ATLETA



 EL EXAMEN MÉDICO DEL ATLETA






Historia clínica: es el método que utiliza el médico para realizar el examen, elaborar un diagnóstico y desarrollar el plan de tratamiento del paciente. La información obtenida debe ser registrada en físico y/o en formato digital y es un documento con valor legal con autoría intelectual de el o los miembros del equipo de salud que atiende al atleta.

La historia clínica es la herramienta más importante de la atención de salud del atleta. Aproximadamente el 10% de los atletas examinados en diferentes programas presentan diagnósticos de situaciones patológicas y del 1% al 2% presentan lesiones, enfermedades o condiciones que condicionen o prohíban la práctica deportiva.
El método de examen es básicamente el mismo en todas las circunstancias, pero las características del abordaje dependen en mayor medida de los requerimientos. Por ejemplo, evaluaciones para despistaje de situaciones patológicas en grandes grupos o pacientes individuales, evaluaciones preparticipación en pacientes con o sin factores de riesgo, evaluaciones de control y seguimiento de lesiones y enfermedades, evaluaciones pre y post temporadas, evaluaciones pre y post rehabilitación, evaluaciones para establecimiento de perfiles deportivos, etc.

UTILIDAD:
1-      Detección de situaciones particulares no patológicas que pudiesen predisponer al atleta a lesiones. Ejemplo: rodillas varo, valgo o recurvatum, codos valgo y/o recurvatum, mujeres con pelvis muy anchas, hiperelasticidad, etc.
2-      Detección de situaciones patológicas que pudiesen verse agravadas con la práctica deportiva (potencialmente mortales o no). Ejemplo: hipertensión arterial, diabetes, arritmias cardíacas, enfermedades infecciosas latentes, etc.
3-      Detección de situaciones patológicas que pudiesen afectar negativamente el rendimiento deportivo. Ejemplo: anemia, trastornos de refracción, desnutrición, etc.
4-      Emisión de certificado de aptitud física para competencias o inicio en la práctica deportiva (calificación o descalificación). Ejemplo: precompetencia de Juegos Olímpicos, Panamericanos, Suramericanos, Bolivarianos, Nacionales, Juvines, Campeonatos Mundiales, etc. También, inscripción o inicio de actividades en academias o clubes deportivos, gimnasios, etc.
5-      Determinación de perfiles deportivos para la orientación hacia la disciplina o especialidad más conveniente para el rendimiento deportivo (clasificación, orientación, selección de talento deportivo, etc.).
6-      Determinación de condiciones especiales para la prescripción médica del ejercicio.
7-      Otras que considere el médico, el atleta, el cuerpo técnico o la institución deportiva.

TIEMPOS DE APLICACIÓN:
1-      Preparticipación: iniciación en la práctica deportiva.
2-      Precompetencia.
3-      Pretemporada.
4-      Postemporada.
5-      Controles regulares durante el macrociclo de entrenamiento (control biomédico del entrenamiento deportivo).
6-      Lesiones.
7-      Aparición de situaciones patológicas.
8-      Otras que considere el médico, el atleta, el cuerpo técnico o la institución deportiva.



LA HISTORIA CLÍNICA. CONTENIDO.

Se presenta un formato de historia clínica convencional con interés en el paciente físicamente activo. El contenido de la misma no necesariamente se aplica en todos los casos. Cada médico, según la situación particular, recolectará la información que considere pertinente. En los casos de evaluación médica a poblaciones sin factores de riesgo que acuden en grupos grandes, el método utilizado es generalmente más sencillo y breve.

I PARTE.
IDENTIFICACIÓN.

Apellidos
Nombres
# de cédula de identidad o pasaporte.
Sexo
Edad
Fecha de nacimiento
Lugar de nacimiento
Grado de instrucción
Profesión
Ocupación u oficio
Dirección de habitación
Teléfono (habitación y celular)
Correo electrónico
PIN
Dirección de trabajo (escuela, universidad)
Teléfono de trabajo (escuela, universidad)
Correo de trabajo (escuela, universidad)
Deporte que practica (principal y otros)
Datos personales de contacto (apellidos, nombres, dirección habitación y trabajo, teléfonos de habitación y trabajo, correo electrónico).
Menores de edad:
Apellidos y nombres del representante legal, # de cédula del representante legal, dirección de habitación y teléfono (habitación y celular) del representante legal, correo electrónico, PIN, dirección, teléfono y correo electrónico de trabajo.


II PARTE. INTERROGATORIO.

Motivo de consulta.
Enfermedad actual.

ANTECEDENTES

Personales niño o adolescente:
Embarazo normal o patológico
A termino, pre término o post término
Parto eutócico o distócico
Cesárea (causa)
Peso al nacer
Talla al nacer
Periodo neonatal
Lactante menor
Lactante mayor
Infancia
Edad en la que comenzó a caminar
Edad en la que comenzó a hablar
Escolaridad
Rendimiento escolar

Personales en general:
Enfermedades crónicas (hipertensión arterial, cardiopatía isquémica, arritmias cardiacas, diabetes, dislipidemias, asma, epilepsia, enfermedades mentales, enfermedades reumáticas, HIV + o SIDA, etc.).
Enfermedades recientes (gripes, gastrointestinales, etc.).
Cardiovasculares y respiratorios (hallazgos o diagnósticos previos de soplos, arritmias, episodios isquémicos, angor, insuficiencia cardíaca, enfermedades valvulares, cirugías o procedimientos invasivos, hipertensión arterial, respuestas tensionales anormales al ejercicio, arritmias inducidas por el ejercicio, angor inducido por el ejercicio, muerte súbita, claudicación, asma crónica o aguda, asma inducida por el ejercicio, episodios recurrentes de disnea, neumonías, alergias respiratorias, etc.).
Desmayos, desvanecimientos, pérdidas del conocimiento, mareos (circunstancias, causas).
Hospitalizaciones (causa, fecha).
Cirugías (causa, fecha).
Medicamentos que consume actualmente (cuáles, por qué).
Alergias (medicamentosas, ambientales, alimentarias, animales, insectos, etc.).
Sangramientos o hemorragias recurrentes.
Episodios psicóticos, crisis nerviosas.
Convulsiones.
Cefaleas frecuentes.
Visión borrosa.
Enfermedades endocrinas (tiroides, etc.).
Cáncer.
Dentales (prótesis, exodoncias, endodoncias, ortodoncia, traumatismos, etc.).
Enfermedades visuales (refracción, glaucoma, retina, traumatismos,  etc.).
Uso de lentes correctivos (extraoculares cristales o de contacto, intraoculares, etc.).
Trastornos auditivos.
Menarquia.
FUR.
Embarazos.
Partos o cesáreas.
Abortos.
Método (s) anticonceptivo(s).
Terapia reemplazo hormonal.
Ultima citología.
Ultima mamografía o eco mamario.
Cirugías ginecológicas.
Características de menstruaciones y ciclo menstrual.
Relación menstruaciones y rendimiento deportivo.
Ultima valoración prostática.
Impotencia.
Ausencia de algún órgano (riñón, testículo, etc.).
Enfermedades infectocontagiosas (varicela, sarampión, rubeola, parotiditis, mononucleosis, hepatitis A, B, C u otras, tuberculosis,  etc.).
Enfermedades de transmisión sexual.
Inmunizaciones (tétanos, varicela, sarampión, rubeola, parotiditis, hepatitis A y B, antigripal, antineumónica, malaria, cólera, fiebre amarilla, otras.).
Lesiones extradeportivas (accidentes laborales, domésticos)
Lesiones deportivas (fracturas, esguinces, dislocaciones, desgarros musculares, desgarros tendinosos, desgarros ligamentarios, etc.).
Traumatismos craneoencefálicos y cervicales.
Knockouts.
Golpe de calor.
Edad de iniciación en el deporte.
Nivel de rendimiento máximo alcanzado.
Nivel de rendimiento actual.
Tipo de entrenamiento actual (supervisión, método, volumen, intensidad, etc.).
Descalificación para la práctica deportiva

Hábitos psicobiológicos:
Alimentación (supervisión, # de comidas diarias, características, etc.).
Sueño (horas habituales y características).
Micciones y evacuaciones.
Sexualidad.
Pareja sexual (estable o no).
Tabaco (edad de inicio, # diario).
Alcohol (edad de inicio, frecuencia, cantidad).
Drogas psicoactivas (marihuana y opiáceos, cocaína en todas sus formas, heroína, psicofármacos, etc.).

Hábitat:
Vivienda (características).
# de habitantes.
Servicios (agua potable, aguas negras, disposición de excretas, luz, teléfono, internet,  recolección de basura, etc.).
Animales y mascotas.
Vectores (zancudos, chipo, etc.).
Entorno ambiental.

Familiares:
Cardiovasculares: hipertensión arterial, cardiopatía isquémica, arritmias cardíacas, muerte súbita, etc.
Respiratorias: asma, etc.
Metabólicas: diabetes, dislipidemias, etc.
Endocrinas: tiroides, etc.
Neurológicas: epilepsia, enfermedades mentales, etc.
Cáncer.

III PARTE.
EXAMEN FÍSICO.

Fecha del examen.
Peso.
Talla.
Grasa corporal (peso y %, método).
Masa magra (peso y %).
Medidas de segmentos corporales (longitud).
Volumen de regiones o segmentos (longitud).
Podometría.
Otras medidas somatométricas.
Signos vitales:
1.    Tensión arterial (a, s y dp).
2.    Frecuencia cardíaca.
3.    Pulso.
4.    Frecuencia respiratoria.
Temperatura.
Examen por aparatos, sistemas y regiones:
Piel y anexos (color, turgencia, lesiones, cabello, etc.).
Boca (mucosas, dentadura, lengua, lesiones, etc.).
Cuello (forma, ganglios, tiroides, masas, lesiones, puntos dolorosos, etc.).
Tórax (forma, lesiones, etc.).
Respiratorio superior (oídos, naríz y garganta).
Respiratorio inferior (pulmones).
Cardiovascular (corazón auscultación, vascular periférico arterial y venoso, etc.)
Abdomen (inspección, forma, palpación y percusión, visceromegalias, malposición de vísceras, inflamación, masas, lesiones, puntos dolorosos, etc.).
Genital (masculino y femenino forma, ubicación, características, etc.).
Características sexuales secundarias (masculino y femenino, desarrollo sexual según escala de Tanner).
Piso pélvico (lesiones perineales, ano, vulva, etc.).
Glándulas mamarias (masculino y femenino forma, tamaño, masas, secreciones, etc.).
Osteomuscular:
Inspección general.
Desarrollo muscular.
Simetría.
Miembros superiores;
1.         Longitud, simetría, configuración, movimientos activos y pasivos, exploración articulaciones, maniobras especiales, fuerza muscular, puntos dolorosos, lesiones, etc.
2.         Hombro (esterno clavicular, gleno humeral, acromio clavicular).
3.         Codo (húmero cubital, radio humeral, cúbito radial).
4.         Muñeca (carpo, cúbito, radio).
5.         Mano (metacarpos, metacarpo falángica, falanges e interfalángicas).
Miembros inferiores:
1.      Pelvis.
2.      Longitud, simetría, configuración, movimientos activos y pasivos, exploración articulaciones, maniobras especiales, fuerza muscular, puntos dolorosos, lesiones, etc.
3.      Cadera: coxo femoral.
4.      Rodilla: fémoro tibial, tibio peroneal, fémoro rotuliana, rótula (posición, crepitación), tendones, ligamentos, meniscos.
5.      Tobillo: peroneo astragalina, tibio astragalina.
6.      Pie: tarso, metatarso, metatarso falángicas, falanges, interfalángicas.
7.      Podograma.
8.      Valoración de la marcha.
Cuello (movilidad, puntos dolorosos, etc.).
Columna vertebral (forma, curvaturas, etc.).
Tronco anterior y posterior (forma, lesiones, movilidad, puntos dolorosos, flexibilidad, etc.).
Neurológico:
1.       Reflejos.
2.       Estado de conciencia.
3.       Fuerza.
4.       Coordinación.
5.       Equilibrio.
6.       Marcha.
7.       Cognitivo.
8.       Funciones superiores.
Órganos de los sentidos:
Ojos (agudeza visual, fondo de ojo, tensión ocular, lesiones, etc.).
Oidos (pabellones auriculares forma y lesiones, CAE lesiones, tímpano, agudeza auditiva, equilibrio, etc.).
Nariz (forma, lesiones, etc.).


IV PARTE.
EXÁMENES COMPLEMENTARIOS.

Laboratorio:
Hemoglobina.
Hematocrito.
Contaje blanco.
Fórmula blanca.
Contaje plaquetario.
Frotis de sangre periférica.
Hierro sérico.
Ferritina.
Transferrina.
Calcio.
Sodio.
Potasio.
Cloruro.
Magnesio.
Fósforo.
Glicemia (ayunas, postprandial).
Insulinemia (ayunas, postprandial).
Curva de tolerancia a la glucosa.
Urea.
Creatinina.
Ácido úrico.
Perfil lipídico.
Grupo sanguíneo y factor Rh.
VDRL.
HIV.
Prueba de embarazo (GCHfB).
Examen de orina.
Examen de heces.
Perfil hormonal.
Screening antidoping.

Imágenes:
Radiografía (RX).
Tomografía axial computarizada (TAC).
Resonancia magnética nuclear (RMN).
Ecosonograma.

Exámenes especiales:
Electrocardiograma (EKG).
Electroencefalograma (EEG).

Valoraciones especiales:
Valoración cardiológica (historia clínica, RX tórax, EKG, ecocardiograma, prueba de esfuerzo).


V PARTE
DIAGNÓSTICO

VI PARTE.
TRATAMIENTO Y CONDUCTA

VII PARTE
RECOMENDACIONES

VIII PARTE
CONTROLES SUCESIVOS




LA CERTIFICACIÓN DE APTITUD FÍSICA.

Este documento de carácter médico-legal se emite luego de completar todos los pasos del método de la historia clínica y corroborar que el paciente se encuentra en condiciones de practicar la actividad física o el deporte en particular sin ningún riesgo para su salud. Esta certificación debe ser específica para cada deporte y tener fecha de vigencia. De ser necesario, el médico que la emite deberá hacer algunas recomendaciones especiales o restricciones especiales.



Quien suscribe hace constar que el atleta_____________________________________________, # de cédula________________________, se encuentra apto físicamente para la práctica de________________________, desde________________hasta________________.
Observaciones y recomendaciones:  ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.


Nombres y apellidos del médico.
Cédula de identidad
MPPS
CM
Firma
Fecha



CONSIDERACIONES ESPECIALES

Para emitir el certificado de aptitud física se recomienda la siguiente conducta:
1-      Menores de 40 años sin factores de riesgo*: historia clínica completa.
2-      Menores de 40 años con factores de riesgo: historia clínica completa, valoración cardiovascular con prueba de esfuerzo (según el caso), exámenes de laboratorio (según el caso), exámenes complementarios (según el caso).
3-      Mayores de 40 años sin factores de riesgo: historia clínica completa, valoración cardiovascular con prueba de esfuerzo (según criterio medico).
4-      Mayores de 40 años con factores de riesgo: historia clínica completa, valoración cardiovascular con prueba de esfuerzo, exámenes de laboratorio (según el caso), exámenes complementarios (según el caso).
5-      Boxeadores y deportes de combate: historia clínica completa, valoración neurológica, electroencefalograma, TAC o RMN cerebral.

*Factores De Riesgo:
Antecedentes personales o familiares de hipertensión arterial, enfermedad cardiaca isquémica, arritmias o de otro tipo, muerte súbita, diabetes, dislipidemias, enfermedad metabólica, sedentarismo, tabaco.


PAUTAS PARA LA DESCALIFICACIÓN DE LA PRÁCTICA DEPORTIVA.

CONDICIÓN
DEPORTE DE CONTACTO
DEPORTE DE RESISTENCIA
DEPORTE RECREATIVO
SENTIDOS
Ojo único
Desprendimiento retina (nuevo o antiguo)
Miopía severa
Hipoacusia severa

X
X

X
Sin consenso


RESPIRATORIO
Tuberculosis activa
Asma mal controlada
Insuficiencia pulmonar
Neumotórax recurrente

X
X
Individualizar
X

X
X
Individualizar

X
Sólo si es aguda
Individualizar
CARDIOVASCULAR
Bloqueo A-V 3er grado
Enf. Valvular cianógena
Coartación aórtica
Carditis reciente
Cirugía cardíaca previa
HTA mal controlada
Arritmia maligna
Arritmia benigna controlada
Enfermedad coronaria avanzada
Enf. Tromboembólica
Prolapso mitral

X
X
X
X
X
X
X
Individualizar

X
X
Individualizar

X
X

X
Individualizar
X
X
Individualizar

X
X
Individualizar

X
Sin consenso

Individualizar
Individualizar
X
X
Individualizar

Individualizar
Individualizar
Individualizar
ABDOMEN
Hepatitis                   
Hepato y/o esplenomegalia
Ictericia

X
X
X

X
X
X

X
X
Individualizar
GENITOURINARIO
Riñón o testículo único, transplante renal
Hernia inguinal/femoral, hidrocele
Testículo atrófico o ND
Nefritis/sind. Nefrótico agudo
Nefritis crónica (uremia)

X

X

X
X
X



X


X
X






X
MUSCULOESQUELÉTICO
Inmadurez física (no funcional)
Enf. Inflamatoria (colágeno/vascular)
Espondilólisis/espondilolistesis con dolor
Lesión aguda o crónica con disfuncionalidad


X
X

X

X



X



X


Individualizar



Individualizar
NEUROLÓGICO
Epilepsia mal controlada
Lesiones cefalomeníngeas hemorrágicas, FX, hidrocefalia, aneurisma, craneotomía previa

X
X

X

X
INFECCIÓN AGUDA
Febril
Severa afebril
Afebril

X
X
X

X
X
X

X
X
Individualizar
HEMOFILIA, TENDENCIA HEMORRÁGICA
X


ANEMIA SEVERA (sang. GI, cél. Falciformes, talasemia)
X
X

LEUCEMIA/LINFOMA
Individualizar
Individualizar
Individualizar
CÁNCER
Individualizar
Individualizar
Individualizar
DIABETES
Mal controlada
Bien controlada

X
Individualizar

X
Individualizar

X
Individualizar
TRAUMATISMOS CRANEOENCEFÁLICOS (C0NCUSIONES) REPETIDAS

X


HIPERTIROIDISMO no controlado
X
X

PIEL (infecciones, herpes, ETS)
X