El entrenamiento de la lucha olímpica para el desarrollo personal y social en adolescentes: una propuesta extracurricular desde la Educación Física / Treinamento da luta-livre olímpica para o desenvolvimento pessoal e social dos adolescentes: uma proposta extracurricular de Educação Física / The training in the Olympic Wrestling for the social and personal development in teenagers: an extracurricular proposal from the Physical Education

RESUMEN El objetivo de este artículo es presentar una propuesta educativa, basada en el entrenamiento de la lucha olímpica para el desarrollo personal y social en adolescentes, en escenarios extracurriculares. Para ello, se utilizaron las metodologías: etnográfica y documental, con la finalidad de poder contestar a la interrogante: ¿Puede haber desarrollo personal y social al entrenar la lucha libre en las instituciones educativas? Se aplicó la revisión bibliográfica en dos fases: la primera, denominada fase I, permitió el análisis de las unidades temáticas seleccionadas para luego asumir una fase II la cual fue propositiva con base en la argumentación teórica y la contextualización que permitiera presentar los objetivos, la metodología pedagógica, la relación con el currículo oficial de Educación Física, las actividades generales y la evaluación para completar algunos vacíos de información. Se aplicó la entrevista a diez profesores de Educación Física de instituciones educativas de la región costa; todos ellos exdeportistas de lucha libre. Ambos instrumentos se basaron bajo dos dimensiones: la primera la lucha olímpica, entre lo curricular y lo extracurricular y la segunda, la lucha olímpica en la formación personal y social del adolescente. Después de hacer un análisis crítico a los resultados, se pudo obtener la propuesta extracurricular de lucha libre. Se aborda la importancia de la implementación de la lucha olímpica como actividad innovadora extracurricular, que potencia el desarrollo personal en cuanto a la autoestima, autocontrol y cuidado de sí mismo, así como habilidades sociales de cooperación, respeto a las reglas y cuidado del otro.

RESUMO O objetivo deste artigo é apresentar uma proposta educativa, baseada na formação da luta olímpica para o desenvolvimento pessoal e social dos adolescentes, em contextos extracurriculares. Para este efeito, foram utilizadas as seguintes metodologias: etnográfica e documental, a fim de responder à pergunta: Pode haver desenvolvimento pessoal e social na formação de luta livre em instituições de ensino? A revisão bibliográfica foi aplicada em duas fases: a primeira, chamada fase I, permitiu a análise das unidades temáticas selecionadas e depois assumir uma fase II que foi propositiva com base na argumentação teórica e na contextualização que permitiu apresentar os objetivos, a metodologia pedagógica, a relação com o currículo oficial da Educação Física, as atividades gerais e a avaliação para completar algumas lacunas de informação. A entrevista foi conduzida com dez professores de Educação Física de instituições educativas da região da costa, todos eles ex-atletas de luta-livre. Ambos os instrumentos se baseavam em duas dimensões: a primeira era a luta olímpica, entre o curricular e extracurricular, e a segunda, a luta olímpica na formação pessoal e social do adolescente. Após uma análise crítica dos resultados, foi obtida a proposta de luta livre extracurricular. É abordada a importância da implementação da luta livre olímpica como actividade extracurricular inovadora, que potência o desenvolvimento pessoal em termos de autoestima, autocontrolo e autocuidado, bem como competências sociais de cooperação, respeito pelas regras e cuidados com os outros.

ABSTRACT The objective of this article is to present an educational proposal based on Olympic Wrestling training for personal and social development in teenagers in extracurricular settings. For this, the ethnographic and documentary methodologies were used in order to answer the question, can there be personal and social development when training wrestling in educational institutions? The bibliographic review was applied in two phases, the first one, called phase I, allowed the analysis of the selected thematic units to later assume a phase II, which was propositional based on the theoretical argumentation and the contextualization that allowed to present the objectives, the pedagogical methodology, the relationship with the official Physical Education curriculum, general activities and evaluation; to fill in some information gaps, the interview was applied to ten physical education teachers from educational institutions in the Costa region, all of them former wrestling athletes. Both instruments were based on two dimensions: the first one, The Olympic Wrestling: between the curricular and the extracurricular, and the second one, The Olympic wrestling in the personal and social formation of the teenagers. After a critical analysis of the results, the extracurricular wrestling proposal was obtained. It addresses the importance of implementing Olympic Wrestling as an innovative extracurricular activity, which promotes personal development in terms of self-esteem, self-control and self-care, as well as social skills of cooperation, respect for rules and care for others.

A standardized vascular disease health check in europe: a cost-effectiveness analysis.

BACKGROUND: No clinical trials have assessed the effects or cost-effectiveness of health check strategies to detect and manage vascular disease. We used a mathematical model to estimate the cost-effectiveness of several health check strategies in six European countries. METHODS: We used country-specific data from Denmark, France, Germany, Italy, Poland, and the United Kingdom to generate simulated populations of individuals aged 40-75 eligible for health checks in those countries (e.g. individuals without a previous diagnosis of diabetes, myocardial infarction, stroke, or serious chronic kidney disease). For each country, we used the Archimedes model to compare seven health check strategies consisting of assessments for diabetes, hypertension, lipids, and smoking. For patients diagnosed with vascular disease, treatment was simulated in a standard manner. We calculated the effects of each strategy on the incidence of type 2 diabetes, major adverse cardiovascular events (MACE), and microvascular complications in addition to quality of life, costs, and cost per quality-adjusted life-year (QALY). RESULTS: Compared with current care, health checks reduced the incidence of MACE (6-17 events prevented per 1000 people screened) and diabetes related microvasular complications (5-11 events prevented per 1000 people screened), and increased QALYs (31-59 discounted QALYs) over 30 years, in all countries. The cost per QALY of offering a health check to all individuals in the study cohort ranged from €14903 (France) to cost saving (Poland). Pre-screening the population and offering health checks only to higher risk individuals lowered the cost per QALY. Pre-screening on the basis of obesity had a cost per QALY of €10200 (France) or less, and pre-screening with a non-invasive risk score was similar. CONCLUSIONS: A vascular disease health check would likely be cost effective at 30 years in Denmark, France, Germany, Italy, Poland, and the United Kingdom.

Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis.

BACKGROUND: No clinical trials have assessed the effects or cost-effectiveness of sequential screening strategies to detect new cases of type 2 diabetes. We used a mathematical model to estimate the cost-effectiveness of several screening strategies. METHODS: We used person-specific data from a representative sample of the US population to create a simulated population of 325,000 people aged 30 years without diabetes. We used the Archimedes model to compare eight simulated screening strategies for type 2 diabetes with a no-screening control strategy. Strategies differed in terms of age at initiation and frequency of screening. Once diagnosed, diabetes treatment was simulated in a standard manner. We calculated the effects of each strategy on the incidence of type 2 diabetes, myocardial infarction, stroke, and microvascular complications in addition to quality of life, costs, and cost per quality-adjusted life-year (QALY). FINDINGS: Compared with no screening, all simulated screening strategies reduced the incidence of myocardial infarction (3-9 events prevented per 1000 people screened) and diabetes-related microvascular complications (3-9 events prevented per 1000 people), and increased the number of QALYs (93-194 undiscounted QALYs) added over 50 years. Most strategies prevented a significant number of simulated deaths (2-5 events per 1000 people). There was little or no effect of screening on incidence of stroke (0-1 event prevented per 1000 people). Five screening strategies had costs per QALY of about US$10,500 or less, whereas costs were much higher for screening started at 45 years of age and repeated every year ($15,509), screening started at 60 years of age and repeated every 3 years ($25,738), or a maximum screening strategy (screening started at 30 years of age and repeated every 6 months; $40,778). Several strategies differed substantially in the number of QALYs gained. Costs per QALY were sensitive to the disutility assigned to the state of having diabetes diagnosed with or without symptoms. INTERPRETATION: In the US population, screening for type 2 diabetes is cost effective when started between the ages of 30 years and 45 years, with screening repeated every 3-5 years. FUNDING: Novo Nordisk, Bayer HealthCare, [corrected] and Pfizer.

Effect of smoking cessation advice on cardiovascular disease.

Performance measures and guidelines encourage physicians to advise smokers to quit. The effect of these efforts on the morbidity, mortality, and cost of cardiovascular disease is not known. This article analyzes the effects of offering smoking cessation advice in the US population. The Archimedes model is used to simulate several clinical trials in which basic advice and medication advice are offered and to calculate the rates of myocardial infarctions, congestive heart disease deaths, strokes, life years, quality-adjusted life years (QALYs), costs, and cost/ QALY. The simulated population is a representative sample of the US population drawn from the Third National Health and Nutrition Survey conducted just before the performance measures and guidelines were introduced. The results show that offering basic advice and medication advice can prevent about 13% and 19% of myocardial infarctions and strokes, respectively. The 30-year cost/QALY is approximately $3000 less than the base-case assumptions and less than $10 000 under pessimistic assumptions.

Relationship of insulin resistance and related metabolic variables to coronary artery disease: a mathematical analysis.

OBJECTIVE: People with diabetes have an increased risk of coronary artery disease (CAD). An unanswered question is what portion of CAD can be attributed to insulin resistance, related metabolic variables, and other known CAD risk factors. RESEARCH DESIGN AND METHODS: The Archimedes model was used to estimate the proportion of myocardial infarctions that would be prevented by maintaining insulin resistance and other risk factors at healthy levels. Person-specific data from the National Health and Nutrition Examination Survey 1998-2004 were used to create a simulated population representative of young adults in the U.S. This population was then entered into a series of simulated clinical trials designed to explore the effects of each risk factor. Each trial had a control arm (all risk factors were allowed to progress without interventions) and a treatment arm (a risk factor was held to its value in young healthy adults). The trials continued for 60 years. The effects of these hypothetical "cures" of each risk factor provide estimates of their impact on CAD. RESULTS: In young adults, preventing insulin resistance would prevent approximately 42% of myocardial infarctions. The next most important determinant of CAD is systolic hypertension, prevention of which would reduce myocardial infarctions by approximately 36%. Following systolic blood pressure, the most important determinants are HDL cholesterol (31%), BMI (21%), LDL cholesterol (16%), triglycerides (10%), fasting plasma glucose and smoking (both approximately 9%), and family history (4%). CONCLUSIONS: Insulin resistance is likely the most important single cause of CAD. A better understanding of its pathogenesis and how it might be prevented or cured could have a profound effect on CAD.

The impact of prevention on reducing the burden of cardiovascular disease.

OBJECTIVE: Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the U.S. RESEARCH DESIGN AND METHODS: We used person-specific data from a representative sample of the U.S. population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20-80 years in the U.S. today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real U.S. population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible. RESULTS: Approximately 78% of adults aged 20-80 years alive today in the U.S. are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by approximately 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced approximately 36% and 20%, respectively. Implementation of all prevention activities would add approximately 221 million life-years and 244 million quality-adjusted life-years to the U.S. adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the U.S. population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years. CONCLUSIONS: Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the U.S. today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.

The impact of prevention on reducing the burden of cardiovascular disease.

OBJECTIVE: Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the United States. RESEARCH DESIGN AND METHODS: We used person-specific data from a representative sample of the US population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20-80 years in the United States today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real US population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible. RESULTS: Approximately 78% of adults aged 20-80 years alive today in the United States are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced 36% and 20%, respectively. Implementation of all prevention activities would add approximately 221 million life-years and 244 million quality-adjusted life-years to the US adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the US population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years. CONCLUSIONS: Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the United States today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.

Diabetes Risk Calculator: a simple tool for detecting undiagnosed diabetes and pre-diabetes.

OBJECTIVE: The objective of this study was to develop a simple tool for the U.S. population to calculate the probability that an individual has either undiagnosed diabetes or pre-diabetes. RESEARCH DESIGN AND METHODS: We used data from the Third National Health and Nutrition Examination Survey (NHANES) and two methods (logistic regression and classification tree analysis) to build two models. We selected the classification tree model on the basis of its equivalent accuracy but greater ease of use. RESULTS: The resulting tool, called the Diabetes Risk Calculator, includes questions on age, waist circumference, gestational diabetes, height, race/ethnicity, hypertension, family history, and exercise. Each terminal node specifies an individual's probability of pre-diabetes or of undiagnosed diabetes. Terminal nodes can also be used categorically to designate an individual as having a high risk for 1) undiagnosed diabetes or pre-diabetes, 2) pre-diabetes, or 3) neither undiagnosed diabetes or pre-diabetes. With these classifications, the sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic area for detecting undiagnosed diabetes are 88%, 75%, 14%, 99.3%, and 0.85, respectively. For pre-diabetes or undiagnosed diabetes, the results are 75%, 65%, 49%, 85%, and 0.75, respectively. We validated the tool using v-fold cross-validation and performed an independent validation against NHANES 1999-2004 data. CONCLUSIONS: The Diabetes Risk Calculator is the only currently available noninvasive screening tool designed and validated to detect both pre-diabetes and undiagnosed diabetes in the U.S. population.

Relación casual entre urticaria crónica y pacientes con infección por helicobater pylori / Relation casual urticary chronic and patients with infection by helicobacter pylori

Con el fin de determinar la relacion casual de la urticaria crónica en pacientes con infección por helicobacter pylori se realizo un estudio prospectivo clínico experimental del tipo ensayo terapéutico a 20 pacientes que acudieron a la consulta externa del Servicio de Medicina Interna del Hospital Dr. Raúl Leoni, San Félix, Bolívar, Venezuela, en el período comprendido desde septiembre del 2001 a febrero del 2002, determinando títulos de Anticuerpos IgG contra Helicobacter pylori, mediante el uso de un kit (InmunoComb* II Helicobacter Pylori IgG) inmunoenzimatico (EIA) indirecto de fase sólida. Del total de pacientes, 8 (40 por ciento) presentaron test positivo (>60 Ul/ml), de los cuales 5 fueron del sexo femenino y 3 del sexo masculino, con edades comprendidas entre 30-40 años. Recibieron tratamiento con el siguiente esquema: Claritromicina 500mg cada 12 horas, Amoxacilina 1000 mg cada 12 horas, Omeprazol 20 mg cada 12 horas durante 10 días. Se realizó un control a la semana y al mes, observándose disminución en los títulos de IgG a valores menores de 20 Ul/ml. Los síntomas asociados en estos pacientes fueron prurito (100 por ciento), acidez gástrica y el reflujo gástrico (30 por ciento). Se establece la relación casual entre la urticaria crónica y Helicobacter pylori; así como la efectividad del tratamiento antibiótico en la remoción del cuadro clínico