The Relative Age Effect in the Two Professional Men's Football Leagues in Spain.

The age difference among individuals of the same group is known as Relative Age. Relative Age Effect refers to the consequences derived from it, such as delayed physical, cognitive and mental development of children born later in the year. The aim of this study was to observe the Relative Age Effect by analyzing players' dates of birth throughout three seasons in the two professional football competitions in Spain based on the game positions and the teams' classification at the end of the season. The sample was made up of players (n=4097) from both professional competitions (nLaLiga Santander=1864), and (nLaLiga Smartbank=2233). The data were collected from two public-access football statistics websites. The cut-off date was established on January 1, the year was divided into four quartiles (Q1: January-March, Q2: April-June, Q3: July-September and Q4: October-December). Results confirmed significant differences on dates of births' distribution (p<0.05) for the competitions - LaLiga Santander and LaLiga Smartbank - during three seasons, as well as for player position, with a larger effect observed for goalkeepers and defenders. Significant difference was also observed depending on classification. Results show a clear decreasing percentage of those born in quartile 4 in relation to those born in quartile 1, it can be concluded that the Relative Age Effect phenomenon is present in the Spanish professional football which may lead to an inappropriate talent selection technique in football, with recruitment oriented to the short term, to immediate results, and possibly caused by the early start of the player selection process.

Psychophysiological Stress Response of Novice Cavers in a Speleology Route.

INTRODUCTION: Speleology/Caving is a recreational outdoor activity that has drawn an increasing number of participants in recent years, but there is little information on the physiological and psychological demands of this outdoor activity. This research aimed to analyze the psychophysiological response of novice cavers to a caving route. METHODS: Modifications in autonomic modulation, ratings of perceived exertion, and perceived stress were evaluated in physically active participants before, during, and after a caving route of 3-h duration. RESULTS: Eighteen participants were assessed. We found an anticipatory anxiety response in the participants before starting the route and significant increases in the ratings of perceived exertion, stress perception, autonomous sympathetic modulation as evaluated by heart rate variability while on the route, and sympathetic modulation 30 min after finishing the caving route. CONCLUSIONS: A speleology route produced an anticipatory anxiety response, an increase in the sympathetic stress response, fatigue symptoms at the autonomic nervous system level, and low perception of stress and effort compared with the autonomic stress response. This information could help to better prepare participants for this demanding event, potentially avoiding accidents and injuries and increasing safety for cavers.

Quality indicators in enteroscopy. Enteroscopy procedure.

Within the project "Quality Indicators in Gastrointestinal Endoscopy," under the leadership of the Sociedad Española de Patología Digestiva (SEPD), our goal is to propose the procedures and the structure, process, and outcome indicators required for the application and assessment of quality in enteroscopy. To this end a search was performed for quality indicators in enteroscopy. Quality of evidence was measured by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, and classified as high, moderate, low, and very low. A total of 10 process indicators (one preprocedure, eight procedure, one postprocedure) were identified for enteroscopy, with appropriate indication and choice of most efficient route being most significant.

Psychophysiological and Specific Fine Motor Skill Modifications in a Checkpoint Action.

In last years, the insurgency attacks on task forces bases and checkpoints have been common. The study of psychophysiological response of soldiers in these asymmetrical and non-controlled situations remains a challenge. The present research aimed to analyze the psychophysiological response and the variations in specific fine motor skill after a checkpoint simulation which included surveillance, unexpected attacks, and melee combat. Psychophysiological parameters -heart rate, blood glucose, pressure, oxygen saturation, and lactate, legs´ strength, skin temperature, cortical activation, anxiety-, as well as fine motor skills were analyzed in a sample of 24 professional Spanish Army soldiers (35.67 ± 6.62 years, 177.21 ± 7.37 cm, 82.29 ± 11.02 kg, 26.17 ± 2.82 BMI, 15.25 ± 7.44 years of experience in their unit) before and after a checkpoint simulation. The checkpoint surveillance operation produced a significant increase (p < 0.05) in rated perceived exertion, heart rate, blood lactate concentration, legs´ strength and somatic anxiety, and a significant decrease in blood oxygen saturation and skin temperature values. We concluded that results were consistent with an activation of sympathetic nervous system, triggering a fight-flight response, a chain of intense psychophysiological reactions and a misinterpretation of perceived exertion. Results may help predicting soldiers´ physical and operative behavior in real situations.

Quality indicators in gastroscopy. Gastroscopy procedure.

Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale.

[More Doctors recruitment program: a new approach to overcome inequalities in human resourcesPrograma Más Médicos: cómo evaluar el impacto de un enfoque innovador para superar las inequidades en recursos humanos]. / Programa Mais Médicos: como avaliar o impacto de uma abordagem inovadora para superação de iniquidades em recursos humanos.

Despite the 40 years elapsed since the Alma-Ata principles were first launched, a series of challenges still persists for the consolidation of primary health care (PHC) as the backbone of health care systems around the world. Among these challenges, especially noteworthy are the issues associated with the inequality in the allocation of human resources. The experience of the More Doctors Program (Programa Mais Médicos, PMM) in Brazil is an example of initiatives that tackle this inconclusive Alma-Ata agenda. By changing key aspects of physician training, provision, and allocation, PMM was shown to be a feasible alternative to minimize the challenge of physician shortage. Assessments of PMM, even though preliminary, have produced positive evidence showing increase in access and improvement of PHC quality in Brazil, a middle income country. Nevertheless, the generation of more robust evidence regarding the impact of PMM on PHC performance indicators is urgent. The discussion proposed in the present article emphasizes the need to prioritize quasi-experimental studies to measure the impact of PMM on population health. The article thus introduces a set of guidelines that may become a useful model to approach challenges associated with the shortage of health care professionals in low and middle income countries.

A pesar de que han transcurrido 40 años desde la proclamación de los principios de Alma-Ata, aún persisten desafíos para la consolidación de la atención primaria de salud (APS) como columna vertebral de los sistemas de atención de salud en todo el mundo. Entre estos desafíos, se destacan los problemas asociados con la desigualdad en la distribución de recursos humanos. La experiencia del Programa Más Médicos (PMM) en Brasil es un ejemplo de las iniciativas que abordan esta agenda inconclusa de Alma-Ata. Al cambiar aspectos clave de la capacitación, la provisión y la asignación de médicos, el PMM demostró ser una alternativa viable para minimizar el desafío de la escasez de profesionales. Las evaluaciones del PMM, aunque preliminares, han producido evidencias positivas que muestran un aumento en el acceso y mejora de la calidad de la APS en Brasil, un país de ingresos medios. Sin embargo, urge generar evidencia más sólida sobre el impacto del PMM en los indicadores de desempeño de la APS. La discusión propuesta en este trabajo enfatiza la necesidad de priorizar estudios cuasiexperimentales para medir el impacto del PMM en la salud de la población. El artículo propone un conjunto de directrices que pueden convertirse en un modelo útil para abordar los desafíos asociados con la escasez de profesionales de la salud en países de ingresos bajos y medios.

Assessment of Psychophysiological Response and Specific Fine Motor Skills in Combat Units.

Soldiers´ training and experience can influence the outcome of the missions, as well as their own physical integrity. The objective of this research was to analyze the psycho-physiological response and specific motor skills in an urban combat simulation with two units of infantry with different training and experience. MATERIAL AND METHODS: psychophysiological parameters -Heart Rate, blood oxygen saturation, glucose and blood lactate, cortical activation, anxiety and heart rate variability-, as well as fine motor skills were analyzed in 31 male soldiers of the Spanish Army, 19 belonging to the Light Infantry Brigade, and 12 to the Heavy Forces Infantry Brigade, before and after an urban combat simulation. RESULTS AND CONCLUSION: A combat simulation provokes an alteration of the psycho-physiological basal state in soldiers and a great unbalance in the sympathetic-vagal interaction. The specific training of Light Infantry unit involves lower metabolic, cardiovascular, and anxiogenic response not only previous, but mainly after a combat maneuver, than Heavy Infantry unit's. No differences were found in relation with fine motor skills, improving in both cases after the maneuver. This fact should be taken into account for betterment units´ deployment preparation in current theaters of operations.

Quality indicators for endoscopic retrograde cholangiopancreatography. The procedure of endoscopic retrograde cholangiopancreatography.

The goal of the project encompassing the present paper is to propose useful quality procedures and indicators in order to improve quality in digestive endoscopy units. In this third part outcome procedures and indicators are suggested for endoscopic retrograde cholangiopancreatography (ERCP). First, a diagram of pre- and post-ERCP steps was developed. A group of experts in healthcare quality and/or endoscopy, under the shelter of the Spanish Society of Digestive Diseases (Sociedad Española de Patología Digestiva - SEPD), carried out a qualitative review of the literature regarding quality indicators for ERCP. Then, a paired analysis was used for the selection of identified references. A total of six specific indicators, apart from the common indicators already described, were identified, all of them process indicators (two pre-procedure and four post-procedure). Evidence quality was analyzed for each indicator using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification.

The Relative Age Effect in the 10 Best Leagues of Male Professional Football of the Union of European Football Associations (UEFA).

The aim of the present research was to observe the relative age effect on professional soccer players of the ten best leagues of the Union of European Football Associations (UEFA), according to the IFFHS (International Federation of Football History and Statistics). The sample consisted of 5201 professional players who participated in the professional leagues during the 2016-2017 season. The birth date of each player was classified in four quartiles (Q1, Q2, Q3 and Q4). The frequencies (fr) and percentages (%) of the birth quartiles were analyzed. The chi square test (X2) and degrees of freedom (gl) were performed to check the differences in the intergroup distribution. Likewise, odd ratios were calculated for the different quartiles, where Q4 was the reference group according to the different leagues studied, playing positions (goalkeeper, defender, midfielder and forward) and classification (first four places, half-of the table and four last places). To calculate the size of the effect on the nominal variables, the Cramer V test was carried out. The results confirmed a greater representation of players born in Q1 and Q2, indicating statistically significant values (p < 0.05) for all the leagues studied, except in the Eerste Klasse A (Belgium). This significance was repeated for the demarcation variables in the field, with a greater effect in the case of the midfielders. Finally, the RAE also affected the three groups according to teams´ classification. The conclusions confirm the effect of the RAE in the sample studied, which would require a review of the talent selection processes in football in order to balance the chances of success of players born at the end of the year.

Effect of Parachute Jump in the Psychophysiological Response of Soldiers in Urban Combat.

The study of organic and psychological response during combat situations has been poorly reported despite its importance for soldiers training and specific instruction, so it was proposed as aim of the present investigation to analyze the effect of a tactical parachute simulated jump in psycho-physiological response of paratroopers' warfighters during an urban combat simulation. 19 male paratroopers (31.9 ± 6.2 year old; 173.6 ± 5.3 cm; 73.8 ± 8.3 Kg) of the Spanish Army were divided in two groups: parachute jump group (n:11) that conducted a simulated parachute jump and a urban combat maneuver and a non-parachute jump group (n:8) that only conducted an urban combat maneuver. We analyzed before and after the maneuver the rated perceived exertion, legs strength manifestation, blood lactate, cortical activation, heart rate variability, blood oxygen saturation and pressure, skin temperature, fine motor skills, and anxiety state. A tactical parachute simulated jump prior to an urban combat maneuver produce significantly (p < 0.05) higher heart rate and decrease in specific fine motor skills in comparison with no jump situation in professional Army paratroopers. Independently of the parachute jump, an urban combat maneuver produces a significant increase in rated perceived exertion, blood lactate, heart rate, legs strength, sympathetic modulation and anxiety response as well as a significant decrease in blood oxygen saturation and parasympathetic modulation.

Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators.

The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.

Socioeconomic inequalities and mortality trends in BRICS, 1990-2010.

OBJECTIVE: To explore the presence and magnitude of--and change in--socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--between 1990 and 2010. METHODS: Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics. FINDINGS: Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. Between-country inequalities in level of education and access to sanitation remained mostly unchanged but the largest between-country difference in mean life expectancy increased, from 9 years in 1990 to 20 years in 2010. Throughout the study period, there was disproportionality in the burden of disease between BRICS. However, the national infant mortality rate fell substantially over the study period in all five countries. In Brazil and China, the magnitude of subnational income-related inequalities in infant mortality, both absolute and relative, also decreased substantially. CONCLUSION: Despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed--within Brazil and China--in the inequalities in income-related levels of infant mortality are encouraging.

Characteristics of tomato plants treated with leaf extracts of neem (Azadirachta indica A. Juss. (L.)) and mata-raton (Gliricidia sepium (Jacquin)): a greenhouse experiment.

Extracts of neem (Azadirachta indica A.) and mata-raton (Gliricidia sepium) leaves were used as insect repellent during organic cultivation of tomato plants (Solanum lycopersicum) and were compared with untreated plants or plants treated with lambda-cyhalothrin (chemical treatment). The best developed tomato plants were found in the Gliricidia treatment, while difference between other treatments were small. The number of different species of macrofauna found on tomato plants were similar in different treatments, except for corn rootworm (Diabrotica spp.) found in the Gliricidia treatment, but not in other treatments. It was found that leaf extract of G. sepium stimulated tomato growth and altered the leaf and fruit characteristics. This was most likely due to its action as a growth regulator and/or an inductor of changes in the tomato growth regulation, but not due to its action as an insect repellent. Consequently, leaf extract of G. sepium could be used to stimulate tomato development.

Predictive value of MicroRNAs in the progression of barrett esophagus to adenocarcinoma in a long-term follow-up study.

OBJECTIVE: The aim of this study is to identify a set of microRNAs (miRNAs) as prognostic molecular biomarkers for the progression of Barrett esophagus (BE) to esophageal adenocarcinoma (EAC) to rationalize the surveillance programs in patients with BE. BACKGROUND: Histological dysplasia is currently used as the main biomarker to identify the BE patients at high risk for developing EAC. Although miRNA expression profiles in BE and EAC have been reported, it has not been established which set of miRNAs could constitute a robust diagnostic test to predict the progression of BE to EAC. METHODS: miRNAs associated with progression of BE to EAC were identified using miRNA sequencing analysis. Further validation by quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed in 2 groups of BE patients who either developed or did not develop adenocarcinoma after at least 5 years of follow-up. RESULTS: Twenty-three miRNAs were identified by miRNA sequencing analysis in the carcinogenesis process associated with BE. qRT-PCR analysis using independent tissue samples confirmed differential expression for 19 of them (miR-let-7c, 7, 146a, 149, 153, 192, 192*, 194, 194*, 196a, 196b, 200a, 203, 205, 215, 424, 625, 625*, and 944). However, only miR-192, 194, 196a, and 196b showed a significantly higher expression in BE samples from patients with progression to EAC compared with those who did not progress to EAC. CONCLUSIONS: These findings suggest that the expression pattern of a modest number of miRNAs in metaplasia biopsies could identify the BE patients at high risk for developing EAC. Therefore, it has potential use for the control and treatment of this malignancy.

Long-term follow-up of malignancy biomarkers in patients with Barrett's esophagus undergoing medical or surgical treatment.

OBJECTIVE: This study aims to compare some validated biomarkers of malignancy (Ki-67, p53, and apoptosis) between 2 groups of patients with Barrett's esophagus (BE) undergoing randomly medical or surgical treatment. BACKGROUND: The treatment of choice to prevent the malignant progression of BE remains controversial. Translational studies using biomarkers associated with the metaplasia-tumor pathway could be useful to provide some information in this regard. METHODS: The study group consisted of 45 patients: 20 under medical treatment with 40 mg/day of proton pump inhibitors (PPIs) and 25 after Nissen fundoplication (NFP). After a median follow-up of 8 years (range, 5-10 years), the values of Ki-67, p53, and apoptosis were analyzed in all patients before treatment (n = 45) and then 1 year (n = 45), 3 years (n = 45), 5 years (n = 45), and 10 years (n = 25) afterwards in both groups of treatment. These values were also analyzed in 2 subgroups of patients with successful medical and surgical treatment. RESULTS: Both Ki-67 and p53 remained stable after NFP, whereas they increased progressively in patients under PPIs with statistically significant differences between the 2 groups. Conversely, the apoptotic index increased progressively after NFP and decreased in the patients under PPIs with significant differences at 3, 5, and 10 years of follow-up. On comparing the subgroups of successful treatment the same differences were found. CONCLUSIONS: Barrett's epithelium remains more stable after a long-term follow-up in patients with BE treated surgically than in those under PPIs even in the absence of abnormal rates of acid reflux.

Advocacy and resource mobilization for rubella elimination in Guatemala.

This review describes the advocacy efforts to mobilize resources for the campaign to vaccinate men and women aged 9-39 years, with a goal of eliminating rubella and congenital rubella syndrome in Guatemala. The country's investment in health has been historically low (0.9% of gross domestic product), and there has been a wide gap between the availability of economic resources and the need for economic resources for the immunization campaign. The review contains a summary of the investment made, the results of advocacy and resource mobilization, the vaccination coverage attained, and the campaign's impact on the disease.

Are Crohn's Disease Patients Limited in Sport Practise? An UltraEndurance Case-Control Study Response.

The aim of this study was to analyze the psychophysiological response of a Crohn's Disease patient in an ultra-endurance event. The psychophysiological responses of a Crohn's Disease and non-Crohn's Disease participant were analysed before during and after an 8 h ultra-endurance running event. Results showed how Crohn's patient presented a similar psychophysiological response than non-Crohn's participant in the ultra-endurance event, except for a higher pre- and post-event sympathetic modulation, lower event sympathetic tone, and lower event body temperature. This study could contribute to improving physical activity recommendations for persons with Crohn's Disease and open a new research line for an improved understanding of psychophysiological modifications of Crohn's Disease patients during exercise.

[Disinfectants and antiseptics facing coronavirus: synthesis of evidence and recommendations]. / Desinfectantes y antisépticos frente al coronavirus: Síntesis de evidencias y recomendaciones.

OBJECTIVE: To synthesize the available evidence on the use of antiseptics and disinfectants in the face of VIDOC-19 infection. METHOD: Bibliographic search in the main databases (WOS, CCC, DIIDW, KJD, MEDLINE, RSCI, SCIELO, PubMed, BMJ Best Practice, Cochrane Library, UptoDate) and on the web of official bodies in March 2020, using descriptors and truncations. The search was limited to reviews published between 2016-2020. RESULTS: Thirty-six papers were identified (no duplicates) of which 17 were selected for relevance and specificity and one paper was added from the literature review. In the documents finally used, no evidence was located, but experiences and recommendations of interest were found, highlighting the importance of material, environmental and, very significantly, hand disinfection. CONCLUSION: There is no clear evidence, nor are there clear recommendations for the use of one or another antiseptic, although the action of sodium hypochlorite, ethanol and hydrogen peroxide is highlighted in comparison to others such as benzalkonium chloride, chlorhexidine digluconate, povidoeyodine and diluted ethyl alcohol. Particular importance is attached to their use in hand hygiene, the use of protective equipment and environmental disinfection.

Airsoft: an efficient and motivating cardiovascular training choice.

BACKGROUND: Obesity and sedentarism have reached pandemic levels, postulating World Health Organization physical exercise as an important key factor for the prevention and treatment. In order to find a motivating and effective physical activity, we conducted this research intending to analyze the physiological and mechanical demands of an airsoft game. METHODS: Cardiovascular and mechanical activity were analyzed by heart rate monitors and GPS in 32 sedentary subjects (27.3±6.2 years; 26.3±7.9 BMI). RESULTS: Participants performed moderate to vigorous aerobic intensity for 3 hours and 20 min of which 55.2% was between 60-70% of their maximal heart rate and 14.2% above 70% of it, turned into distance 9.5 km of which 91.5% was moderate and 8.5% vigorous intensity. CONCLUSIONS: A single airsoft game performed by sedentary subject exceed the international recommendation of physical activity and weekly physical activity of US adults' citizens. This motivating and outdoor activity is an effective alternative to increase the population's physical activity levels.