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1.
Comput Math Methods Med ; 2022: 2474951, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35265167

RESUMEN

Particle crowd algorithmic rule is a mayor examination hotspot in the authentic optimization algorithmic rule respond. Based on the PSO algorithmic rule to make optimal the RBFNN example, an amended order of nonlinear adaptable laziness power supported on the contest of population variegation is intended to extend the fixedness of population unlikeness performance and hunt capabilities to preclude the algorithmic rule from dripping into a topical extreme point prematurely, thereby further improving the prophecy correctness. Simulation experience shows that the amended PSO-RBFNN standard has open advantageous in the fixedness and sharp convergency of the prognosis proceed. In fashion to reprove the justness of reverse kinematics of robots with composite make and supercilious degrees of liberty, an amended adaptative suffix abound optimization (IAPSO) is spoken. First, the motoric equality of the 6-DOF strength-example avaricious robot design is established by the amended DH (Denavit-Hartenberg) argument course; second, on the base of the existent morsel abound algorithmic rule, the population Manhattan ceremoniousness is interested to lead the maneuver condition of the population in aqiqiy measure. And bound the adaptative lore substitute accordingly to the dissimilar maneuver possession and then adopt distinct site and hurry update modes; lastly, the fitness province with handicap substitute is present to trial the honest-prick and extended course transposition of the robot mold, and the delusion is not joint product major than 0.005 rad. The feint inference shows that the established kinematics shape is chasten, and the amended algorithmic program captures into recital the nicety, uniqueness, and velocity of the inverted resolution of the existent PSO algorithmic program, as well as higher deliverance truths. We conduct an experiment on the Brazilian jiu-jitsu. The results have clearly shown the advantage of our method.


Asunto(s)
Algoritmos , Ejercicio Físico/fisiología , Indicadores de Salud , Brasil , Biología Computacional , Simulación por Computador , Prueba de Esfuerzo/estadística & datos numéricos , Estado de Salud , Humanos , Artes Marciales/fisiología , Redes Neurales de la Computación , Dinámicas no Lineales , Aptitud Física/fisiología
2.
Ther Apher Dial ; 25(3): 304-313, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32777142

RESUMEN

Serum carnitine is decreased in hemodialysis patients, which induces muscle atrophy. Thus, we examined the different effects of l-carnitine and exercise on exercise activity and muscle status in hemodialysis patients. Twenty patients were divided into l-carnitine and cycle ergometer groups and were followed for 3 months. Muscle and fat mass, physical activities, and muscle status were evaluated by an impedance, physical function test, and magnetic resonance imaging, respectively. The l-carnitine significantly increased muscle mass (P = .023) and thigh circumference (P = .027), decreased fat mass (P = .007), and shortened chair stand-up time (P = .002) and 10-m walk test (P = .037). The fat fraction was improved by the l-carnitine (P = .047). Compared with the exercise group, l-carnitine improved the changes in 10-m walk test (P = .026), chair stand-up time (P = .014), and thigh circumference (P = .022). Baseline fibroblast growth factor-21 and myostatin levels predicted the l-carnitine-associated changes in exercise activities. l-carnitine, rather than exercise, improved physical activity and muscle status in hemodialysis patients.


Asunto(s)
Carnitina/administración & dosificación , Suplementos Dietéticos , Prueba de Esfuerzo/métodos , Ejercicio Físico/fisiología , Músculos/efectos de los fármacos , Diálisis Renal , Carnitina/sangre , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Humanos , Japón , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Músculos/diagnóstico por imagen , Músculos/fisiología , Estudios Prospectivos
3.
PLoS One ; 14(9): e0222982, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31550286

RESUMEN

This study investigated the effect of open-placebo on cycling time-trial (TT) performance. Twenty-eight trained female cyclists completed a 1-km cycling TT following a control session or an open-placebo intervention. The intervention consisted of an individual presentation, provided by a medic, in which the concept of open-placebo was explained to the participant, before she ingested two red and white capsules containing flour; 15 min later, they performed the TT. In the control session, the participant sat quietly for 20 min. Heart rate and ratings of perceived exertion (RPE) were monitored throughout exercise, while blood lactate was determined pre- and post-exercise. Post-exercise questionnaires were employed to gain insight into the perceived influence of the supplement on performance. Open-placebo improved time-to-completion (P = 0.039, 103.6±5.0 vs. 104.4±5.1 s, -0.7±1.8 s, -0.7±1.7%) and mean power output (P = 0.01, 244.8±34.7 vs. 239.7±33.2, +5.1±9.5 W) during the TT. Individual data analysis showed that 11 individuals improved, 13 remained unchanged and 4 worsened their performance with open-placebo. Heart rate, RPE and blood lactate were not different between sessions (all P>0.05). Positive expectation did not appear necessary to induce performance improvements, suggesting unconscious processes occurred, although a lack of an improvement appeared to be associated with a lack of belief. Open-placebo improved 1-km cycling TT performance in trained female cyclists. Although the intervention was successful for some individuals, individual variation was high, and some athletes did not respond or even performed worse. Thus, open-placebo interventions should be carefully considered by coaches and practitioners, while further studies are warranted.


Asunto(s)
Rendimiento Atlético/psicología , Ciclismo/psicología , Suplementos Dietéticos , Adulto , Rendimiento Atlético/fisiología , Ciclismo/fisiología , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Humanos , Resistencia Física , Efecto Placebo , Factores de Tiempo
4.
Ann Emerg Med ; 74(2): 216-223, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30955986

RESUMEN

STUDY OBJECTIVE: Professional guidelines recommend 72-hour cardiac stress testing after an emergency department (ED) evaluation for possible acute coronary syndrome. There are limited data on actual compliance rates and effect on patient outcomes. Our aim is to describe rates of completion of noninvasive cardiac stress testing and associated 30-day major adverse cardiac events. METHODS: We conducted a retrospective analysis of ED encounters from June 2015 to June 2017 across 13 community EDs within an integrated health system in Southern California. The study population included all adults with a chest pain diagnosis, troponin value, and discharge with an order for an outpatient cardiac stress test. The primary outcome was the proportion of patients who completed an outpatient stress test within the recommended 3 days, 4 to 30 days, or not at all. Secondary analysis described the 30-day incidence of major adverse cardiac events. RESULTS: During the study period, 24,459 patients presented with a chest pain evaluation requiring troponin analysis and stress test ordering from the ED. Of these, we studied the 7,988 patients who were discharged home to complete diagnostic testing, having been deemed appropriate by the treating clinicians for an outpatient stress test. The stress test completion rate was 31.3% within 3 days and 58.7% between 4 and 30 days, and 10.0% of patients did not complete the ordered test. The 30-day rates of major adverse cardiac events were low (death 0.0%, acute myocardial infarction 0.7%, and revascularization 0.3%). Rapid receipt of stress testing was not associated with improved 30-day major adverse cardiac events (odds ratio 0.92; 95% confidence interval 0.55 to 1.54). CONCLUSION: Less than one third of patients completed outpatient stress testing within the guideline-recommended 3 days after initial evaluation. More important, the low adverse event rates suggest that selective outpatient stress testing is safe. In this cohort of patients selected for outpatient cardiac stress testing in a well-integrated health system, there does not appear to be any associated benefit of stress testing within 3 days, nor within 30 days, compared with those who never received testing at all. The lack of benefit of obtaining timely testing, in combination with low rates of objective adverse events, may warrant reassessment of the current guidelines.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Dolor en el Pecho/diagnóstico , Prueba de Esfuerzo/normas , Infarto del Miocardio/diagnóstico , Síndrome Coronario Agudo/mortalidad , Enfermedad Aguda , Anciano , Dolor en el Pecho/etiología , Toma de Decisiones Clínicas , Servicio de Urgencia en Hospital , Prueba de Esfuerzo/métodos , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Mortalidad/tendencias , Infarto del Miocardio/epidemiología , Revascularización Miocárdica/estadística & datos numéricos , Estudios Observacionales como Asunto , Evaluación de Resultado en la Atención de Salud , Alta del Paciente/tendencias , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad , España/epidemiología , Troponina/sangre
5.
Mil Med ; 183(5-6): e182-e187, 2018 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-29447399

RESUMEN

Background: The 20-m shuttle run test (MSRT) is a common field test used to measure aerobic fitness in controlled environments. The U.S. Army currently assesses aerobic fitness with the two-mile run (TMR), but external factors may impact test performance. The aim of this study is to examine the relationship between the Army Physical Fitness Test TMR performance and the MSRT in military personnel. Methods: A group of 531 (403 males and 128 females) active duty soldiers (age: 24.0 ± 4.1 years) performed the MSRT in an indoor facility. Heart rate was monitored for the duration of the test. Post-heart rate and age-predicted maximal heart rate were utilized to determine near-maximal performance on the MSRT. The soldiers provided their most recent Army Physical Fitness Test TMR time (min). A Pearson correlation and multiple linear regression analyses were performed to examine the relationship between TMR time (min) and MSRT score (total number of shuttles completed). The study was approved by the Human Use Review Committee at the U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts. Findings: A significant, negative correlation exists between TMR time and MSRT score (r = -0.75, p < 0.001). Sex and MSRT score significantly predicted TMR time (adjusted R2 = 0.65, standard error of estimate = 0.97, p < 0.001) with a 95% ratio limits of agreement of ±12.6%. The resulting equation is: TMR = 17.736-2.464 × (sex) - 0.050 × (MSRT) - 0.026 × (MSRT × sex) for predicted TMR time. Males equal zero, females equal one, and MSRT score is the total number of shuttles completed. Discussion: The MSRT is a strong predictor of the TMR and should be considered as a diagnostic tool when assessing aerobic fitness in active duty soldiers.


Asunto(s)
Personal Militar/educación , Rendimiento Físico Funcional , Carrera/normas , Rendimiento Laboral/normas , Adulto , Índice de Masa Corporal , Electrocardiografía/métodos , Prueba de Esfuerzo/métodos , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Carrera/estadística & datos numéricos , Rendimiento Laboral/estadística & datos numéricos
6.
Mil Med ; 183(7-8): e270-e277, 2018 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-29420813

RESUMEN

Background: Competitive athletes train body and mind in preparation for competition with mental fortitude often providing the "winning edge." Similarly, the current-day warfighter faces significant physical and psychological challenges and must be prepared to respond to life-threatening danger with mental and physical agility. Sport Psychology for the Soldier Athlete recognizes the soldier as an elite athlete and provides training required to perform at the highest caliber. Through this curriculum, mental skills coaching in goal setting, imagery, positive self-talk, and heart rate control is integrated into routine physical fitness training. These skills commonly used by professional and Olympic athletes for optimal performance provide soldiers with the ability to manage every day military stressors. Sport Psychology for the Soldier Athlete supports GEN Milley's top priority of readiness and decreases the cost of Army Physical Fitness Test (APFT) failures. Procedures: Soldiers from a large military treatment facility participated in a 6-wk sport psychology mental skills training program led by an Army occupational therapist. The training that was integrated into regularly scheduled physical training consisted of 10 min of physical readiness training, 10 min of mental skills coaching followed by push-up, sit-up, and running drills focusing on the mental skills learned. Semi-annual APFT scores following the sport psychology training were compared with the five previous semi-APFT scores for the same company using analysis of variance. Findings: Results comparing company APFT scores to the previous five semi-annual tests showed statistical significance of 0.001 with the intervention group achieving an average 13- to 14-point improvement. Post-training survey showed 91% of participants recognizing the benefit of these "life skills" in other Army tasks such as weapons qualification, combat medic tasks, and career planning. Soldiers acknowledged this curriculum as quality hands-on training with the suggestion for further development. Discussion: A proactive approach to incorporating mental skills training into the military culture, Sport Psychology for the Soldier Athlete, is in direct alignment with The Army Human Dimension Strategy of developing mental and physical proficiency. This paradigm shift is both timely and necessary for answering readiness and resilience needs of U.S troops and provides additional tools for attaining optimal physical and mental endurance.


Asunto(s)
Atletas/psicología , Personal Militar/psicología , Deportes/normas , Adulto , Análisis de Varianza , Atletas/estadística & datos numéricos , Índice de Masa Corporal , Prueba de Esfuerzo/métodos , Prueba de Esfuerzo/estadística & datos numéricos , Frecuencia Cardíaca , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Autoeficacia , Deportes/psicología , Deportes/estadística & datos numéricos , Encuestas y Cuestionarios
7.
Mil Med ; 182(1): e1603-e1609, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-28051980

RESUMEN

INTRODUCTION: Dietary intake of military initial entry trainees is often inadequate because of the structured food environment, lack of snacking, and limited time for meals. Inadequate intake during training increases risk for injury, poor performance, and attrition from training. A performance nutrition initiative was implemented at Joint Base San Antonio Lackland to mitigate this inadequacy in Air Force trainees and better reflect recommendations for active populations and mitigate nutritional inadequacy. MATERIALS AND METHODS: Trainees (N = 867) in two squadrons either received a nutrition bar before bed (snack squadron n = 423) or did not (standard squadron n = 444). This study retrospectively compared trainees' attrition and fitness measures as recorded in the Basic Military Training (BMT) Surveillance database. RESULTS: Both groups had similar rates of attrition and graduation at the end of 8 weeks (p = 0.23). At the start of training, only one out of four trainees in either Squadron passed the Physical Fitness Assessment (PFA). Although both squadrons' fitness measures improved as a result of the effects of training, the snack squadron had a significantly greater percent improvement in all PFA categories (p < 0.001), as represented by improved muscular fitness measures (p < 0.001), decreased median run time (p = 0.001), and greater improvement in scaled run scores (p = 0.013) as compared to the standard squadron. Those who received the snack were 1.62 (confidence interval: 1.2-2.2) times more likely to pass the PFA at 4 weeks than those who did not receive the snack. CONCLUSION: This study shows that military trainees' fitness improves with a modest nutritional supplement and suggests that optimizing overall nutrition benefits trainees. Attrition from BMT costs the U.S. Air Force up to $22,000 per trainee lost. In contrast, a trainee could receive one nutrition bar per day during BMT for $34. As the nutrition bar initiative improves fitness as well as costs less than recruiting and medically treating trainees whom ultimately attrite from training, the snack intervention was beneficial. Future studies of strategic nutrition interventions in military training populations can help trainees to better meet their macronutrient and micronutrient needs and further optimize training performance.


Asunto(s)
Dieta/normas , Educación/normas , Prueba de Esfuerzo/normas , Personal Militar/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos , Adolescente , Dieta/estadística & datos numéricos , Educación/estadística & datos numéricos , Ejercicio Físico , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Humanos , Masculino , Estado Nutricional , Evaluación de Programas y Proyectos de Salud/normas , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Factores de Tiempo , Estados Unidos , Adulto Joven
8.
J Sports Sci ; 34(5): 477-85, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26119031

RESUMEN

Different countries have different methods for assessing movement competence in children; however, it is unclear whether the test batteries that are used measure the same aspects of movement competence. The aim of this paper was to (1) investigate whether the Test of Gross Motor Development (TGMD-2) and Körperkoordinations Test für Kinder (KTK) measure the same aspects of children's movement competence and (2) examine the factorial structure of the TGMD-2 and KTK in a sample of Australian children. A total of 158 children participated (M age = 9.5; SD = 2.2). First, confirmatory factor analysis examined the independent factorial structure of the KTK and TGMD-2. Second, it was investigated whether locomotor, object control and body coordination loaded on the latent variable Movement Competency. Confirmatory factor analysis indicated an adequate fit for both the KTK and TGMD-2. An adequate fit was also achieved for the final model. In this model, locomotor (r = .86), object control (r = .71) and body coordination (r = .52) loaded on movement competence. Findings support our hypothesis that the TGMD-2 and KTK measure discrete aspects of movement competence. Future researchers and practitioners should consider using a wider range of test batteries to assess movement competence.


Asunto(s)
Prueba de Esfuerzo/métodos , Modelos Estadísticos , Actividad Motora/fisiología , Destreza Motora/fisiología , Antropometría , Australia , Niño , Prueba de Esfuerzo/estadística & datos numéricos , Análisis Factorial , Femenino , Humanos , Masculino , Movimiento/fisiología , Reproducibilidad de los Resultados
9.
J Med Assoc Thai ; 98 Suppl 3: S110-4, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26387397

RESUMEN

OBJECTIVE: To study efficacy and safety of fish oil in treatment of knee osteoarthritis. MATERIAL AND METHOD: 75 participants had divided into three groups of 25 people to study efficacy results after taking fish oil 1,000 mg and 2,000 mg once a day for 8 weeks. 1,000 mg of fish oil have EPA 400 mg and DHA 200 mg. All participants had complete visual analog scale for measuring knee pain and knee function. They also had measured 100 meters walking velocity and three steps walking time before taking fish oil. Then they had re-measured all parameters again at 8-12 weeks after taking fish oil to compare the results. RESULTS: All parameters had statistically significant better differences in the group of participants who had taken fish oil when compared to the control group. The average score of patient's satisfaction was 9.06 of 10 and also by verbal response of 50 participants; everyone felt good and happy with fish oil. One participant had hematuriafrom silent CA bladder at 10th week but the other 49 participants were safe without any complications from fish oil. CONCLUSION: Fish oil 1,000-2,000 mg daily supplementation had significant efficacy to improve knee performance and also are safe in mild to moderate stages of knee osteoarthritics patients. However higher dose 2,000 mg of fish oil had not significant higher efficacy than 1,000 mg of fish oil.


Asunto(s)
Aceites de Pescado/farmacología , Osteoartritis de la Rodilla/tratamiento farmacológico , Adulto , Anciano , Suplementos Dietéticos , Ácidos Docosahexaenoicos , Relación Dosis-Respuesta a Droga , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Aceites de Pescado/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Dolor/tratamiento farmacológico , Dolor/etiología , Satisfacción del Paciente/estadística & datos numéricos , Rango del Movimiento Articular/efectos de los fármacos , Resultado del Tratamiento , Caminata
10.
J Cardiopulm Rehabil Prev ; 35(5): 356-66, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26181038

RESUMEN

PURPOSE: The evidence regarding the effects of pulmonary rehabilitation (PR) on health care resource use remains limited. This retrospective study evaluated the effects of PR on the primary outcome of all-cause hospitalizations and secondary outcomes of other health care use, exercise capacity, health-related quality of life (HRQOL), and body weight in patients with chronic obstructive pulmonary disease (COPD) in a large integrated health care system. METHODS: The PR cohort included 558 patients with a COPD diagnosis, age ≥ 40 years, who were treated with a bronchodilator or steroid inhaler, participated in 1 of 13 PR programs between January 1, 2008, and August 1, 2013, and were continuously enrolled in the health plan ≥ 12 months prior to and after PR. Two non-PR control cohorts were assembled for comparison. Data were extracted from electronic health records. The 6-minute walk test and St. George's Respiratory Questionnaire results were available for a subset. RESULTS: The proportion of patients who were hospitalized 12 months post-PR was lower compared with the 12 months prior (37% vs 45%, P = .001) while emergency department use was not different (52% vs 54%). Patients who declined PR for logistical reasons had a 40% higher risk of hospitalization than PR participants (relative risk = 1.40, 95% CI: 0.96-2.06, P = .08). There were significant improvements in the 6-minute walk test distance (+43 m) and the St. George's Respiratory Questionnaire total score (-9.6 points) but minimal changes in weight. CONCLUSIONS: Our finding that participation in PR is associated with reductions in hospitalizations corroborates previous studies. A notable strength of this study is the capture of complete utilization data.


Asunto(s)
Prestación Integrada de Atención de Salud , Hospitalización/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Anciano , Broncodilatadores/uso terapéutico , Estudios de Cohortes , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Calidad de Vida , Estudios Retrospectivos , Encuestas y Cuestionarios , Caminata
11.
Appl Physiol Nutr Metab ; 40(5): 457-63, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25884315

RESUMEN

This study aimed to investigate whether isolated or combined carbohydrate (CHO) and caffeine (CAF) supplementation have beneficial effects on performance during soccer-related tests performed after a previous training session. Eleven male, amateur soccer players completed 4 trials in a randomized, double-blind, and crossover design. In the morning, participants performed the Loughborough Intermittent Shuttle Test (LIST). Then, participants ingested (i) 1.2 g·kg(-1) body mass·h(-1) CHO in a 20% CHO solution immediately after and 1, 2, and 3 h after the LIST; (ii) CAF (6 mg·kg(-1) body mass) 3 h after the LIST; (iii) CHO combined with CAF (CHO+CAF); and (iv) placebo. All drinks were taste-matched and flavourless. After this 4-h recovery, participants performed a countermovement jump (CMJ) test, a Loughborough Soccer Passing Test (LSPT), and a repeated-sprint test. There were no main effects of supplementation for CMJ, LSPT total time, or best sprint and total sprint time from the repeated-sprint test (p>0.05). There were also no main effects of supplementation for heart rate, plasma lactate concentration, rating of perceived exertion (RPE), pleasure-displeasure, and perceived activation (p>0.05). However, there were significant time effects (p<0.05), with heart rate, plasma lactate concentration, RPE, and perceived activation increasing with time, and pleasure-displeasure decreasing with time. In conclusion, isolated and/or combined CHO and CAF supplementation is not able to improve soccer-related performance tests when performed after a previous training session.


Asunto(s)
Rendimiento Atlético/estadística & datos numéricos , Cafeína/farmacología , Carbohidratos de la Dieta/farmacología , Suplementos Dietéticos , Prueba de Esfuerzo/estadística & datos numéricos , Fútbol , Adulto , Estudios Cruzados , Método Doble Ciego , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Ácido Láctico/sangre , Masculino , Factores de Tiempo
12.
G Ital Cardiol (Rome) ; 15(4): 244-52, 2014 Apr.
Artículo en Italiano | MEDLINE | ID: mdl-24873814

RESUMEN

In recent years, a progressive increase in the number of medical diagnostic and interventional procedures has been observed, namely in cardiology. A significant proportion of them appear inappropriate, i.e. potentially redundant, harmful, costly, and useless. Recently, the document Medical Professionalism in the New Millennium: A Physician Charter, the American Board of Internal Medicine (ABIM) Foundation Putting the Charter into Practice program, JAMA's Less Is More and BMJ's Too Much Medicine series, and the American College of Physicians' High-Value, Cost-Conscious Care initiatives, have all begun to provide direction for physicians to address pervasive overuse in health care. In 2010, the Brody's proposal to scientific societies to indicate the five medical procedures at high inappropriateness risk inspired the widely publicized ABIM Foundation's Choosing Wisely campaign. As part of Choosing Wisely, each participating specialty society has created lists of Things Physicians and Patients Should Question that provide specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate individual care. In Italy, Slow Medicine launched the analogue campaign Fare di più non significa fare meglio. The Italian Association of Hospital Cardiologists (ANMCO) endorsed the initiative by recognizing the need to optimize available resources, reduce costs and avoid unnecessary cardiovascular assessments, thereby enhancing the more efficient care delivery models. An ad hoc ANMCO Working Group prepared a list of five cardiac procedures that seem inappropriate for routine use in our country and, after an internal revision procedure, these are presented here.


Asunto(s)
Cardiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/terapia , Manejo de la Enfermedad , Mal Uso de los Servicios de Salud/prevención & control , Prescripción Inadecuada/prevención & control , Sociedades Médicas , Procedimientos Innecesarios , Cardiología/economía , Cardiología/normas , Fármacos Cardiovasculares/economía , Fármacos Cardiovasculares/uso terapéutico , Ahorro de Costo , Toma de Decisiones , Diagnóstico por Imagen/economía , Diagnóstico por Imagen/estadística & datos numéricos , Técnicas de Diagnóstico Cardiovascular/economía , Técnicas de Diagnóstico Cardiovascular/estadística & datos numéricos , Ecocardiografía/estadística & datos numéricos , Electrocardiografía Ambulatoria/estadística & datos numéricos , Medicina Basada en la Evidencia , Prueba de Esfuerzo/estadística & datos numéricos , Medicina Familiar y Comunitaria/normas , Humanos , Medicina Interna/normas , Italia , Programas Nacionales de Salud/normas , Pediatría/normas , Sociedades Médicas/normas , Procedimientos Innecesarios/economía
13.
Can J Cardiol ; 29(12): 1579-85, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23948088

RESUMEN

BACKGROUND: There has been limited research exploring socioeconomic inequity in targeted preventive care for acute myocardial infarction (AMI). The objective of this study was to examine socioeconomic disparities in the use of primary and secondary preventive services relevant to the identification and management of heart disease in a cohort of patients with AMI. METHODS: Preventive services used before the AMI event were examined in a cohort of 30,491 patients with first-time AMI in Ontario, Canada from 2010 to 2012. Using logistic regression, socioeconomic differences in lipid testing, glucose testing, stress testing, electrocardiography (ECG), and echocardiography in middle-aged and older patients were examined. RESULTS: For many of the services, there were no differences in the use of primary and secondary preventive services between patients according to socioeconomic status; however, a number of exceptions were found. Controlling for other factors, we found that for primary preventive services, low-income middle-aged patients had 13% (95% confidence interval [CI], 0.790-0.967) and 10% (95% CI, 0.812-0.997) lower odds of receiving lipid and glucose testing, respectively, when compared with high-income middle-aged patients. Controlling for other factors, we found that for secondary preventive services, low-income middle-aged and older patients had 24% (95% CI, 1.087-1.415) and 10% (95% CI, 1.012-1.202) higher odds of receiving echocardiography when compared with their high-income counterparts. CONCLUSIONS: Socioeconomic disparities in primary and secondary preventive services for patients with AMI could not be demonstrated in many instances. However, inequities in primary preventive care were found in middle-aged patients receiving lipid and glucose testing, which may have implications for Canadian health policy to ensure healthy aging across the age spectrum.


Asunto(s)
Disparidades en Atención de Salud , Infarto del Miocardio/prevención & control , Factores Socioeconómicos , Anciano , Glucemia/análisis , Ecocardiografía/estadística & datos numéricos , Electrocardiografía/estadística & datos numéricos , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Lípidos/sangre , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Infarto del Miocardio/sangre , Programas Nacionales de Salud/estadística & datos numéricos , Ontario , Prevención Secundaria , Cobertura Universal del Seguro de Salud/estadística & datos numéricos , Revisión de Utilización de Recursos/estadística & datos numéricos
14.
Med Eng Phys ; 28(7): 710-8, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16298543

RESUMEN

AIM: The energy efficiency of FES-cycling in spinal cord injured subjects is very much lower than that of normal cycling, and efficiency is dependent upon the parameters of muscle stimulation. We investigated measures which can be used to evaluate the effect on cycling performance of changes in stimulation parameters, and which might therefore be used to optimise them. We aimed to determine whether oxygen cost and stimulation cost measurements are sensitive enough to allow discrimination between the efficacy of different activation ranges for stimulation of each muscle group during constant-power cycling. METHODS: We employed a custom FES-cycling ergometer system, with accurate control of cadence and stimulated exercise workrate. Two sets of muscle activation angles ("stimulation patterns"), denoted "P1" and "P2", were applied repeatedly (eight times each) during constant-power cycling, in a repeated measures design with a single paraplegic subject. Pulmonary oxygen uptake was measured in real time and used to determine the oxygen cost of the exercise. A new measure of stimulation cost of the exercise is proposed, which represents the total rate of stimulation charge applied to the stimulated muscle groups during cycling. A number of energy-efficiency measures were also estimated. RESULTS: Average oxygen cost and stimulation cost of P1 were found to be significantly lower than those for P2 (paired t-test, p<0.05): oxygen costs were 0.56+/-0.03l min-1 and 0.61+/-0.04l min-1 (mean+/-S.D.), respectively; stimulation costs were 74.91+/-12.15 mC min-1 and 100.30+/-14.78 mC min-1 (mean+/-S.D.), respectively. Correspondingly, all efficiency estimates for P1 were greater than those for P2. CONCLUSION: Oxygen cost and stimulation cost measures both allow discrimination between the efficacy of different muscle activation patterns during constant-power FES-cycling. However, stimulation cost is more easily determined in real time, and responds more rapidly and with greatly improved signal-to-noise properties than the ventilatory oxygen uptake measurements required for estimation of oxygen cost. These measures may find utility in the adjustment of stimulation patterns for achievement of optimal cycling performance.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/terapia , Ingeniería Biomédica , Terapia por Estimulación Eléctrica/instrumentación , Terapia por Estimulación Eléctrica/estadística & datos numéricos , Prueba de Esfuerzo/instrumentación , Prueba de Esfuerzo/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Contracción Muscular/fisiología , Oxígeno/fisiología , Paraplejía/fisiopatología , Paraplejía/terapia
15.
Saudi Med J ; 26(5): 848-50, 2005 May.
Artículo en Inglés | MEDLINE | ID: mdl-15951881

RESUMEN

OBJECTIVE: The purpose of the present study was to examine the validity of using a 20 meter multistage shuttle run test to estimate maximal oxygen uptake. METHODS: Twenty-two elite taekwondo athletes (11 male, 11 female, members of the Turkish young national team), participated in the study. The respiratory gas exchange parameters were measured using portable gas analysis system while shuttle run test was carried out. All tests were performed last August 2004, in the gymnasium of Suleyman Demirel University, Isparta, Turkey. RESULTS: Analysis of the test scores showed a mean score on gas analysis of 51.79 ml/kg/min and a mean score of 43.59 ml/kg/min on the shuttle run test. On average, the scores predicted by the shuttle run test were 16% lower than those for the gas analysis score. The correlation between the tests was significant at a level of r = 0.810. CONCLUSION: Maximal oxygen consumption (VO2 max) can be predicted from shuttle run test scores, but not as indicated with the test package. In order to obtain the true score one must apply a regression equation.


Asunto(s)
Prueba de Esfuerzo/estadística & datos numéricos , Predicción , Consumo de Oxígeno , Análisis de Regresión , Adolescente , Femenino , Humanos , Masculino , Artes Marciales , Reproducibilidad de los Resultados , Carrera , Turquía
16.
Selección (Madr.) ; 13(4): 142-147, oct.-dic. 2004. tab
Artículo en Es | IBECS | ID: ibc-37200

RESUMEN

El objetivo de este trabajo ha sido analizar la relación entre determinados parámetros del modelo respiratorio y la transición aeróbica-anaeróbica. Veintidós varones (24.9 +/- 4.1) años (Media +/- SD) y 11 mujeres (21.7 +/- 2.1) años, realizaron una prueba de esfuerzo máxima. La transición aeróbica-anaeróbica fue analizada mediante dos métodos: 1º el método ventilatorio y 2º el cambio de los tiempos respiratorios y sus inversos. Los criterios para la determinación de los umbrales ventilatorios por ambos métodos fue llevado a cabo por 4 observadores, 2 sin experiencia y 2 con experiencia. La correlación de Pearson para los valores medios de los 4 observadores fue: r= 0.55 +/- 0.23 para VT1 (ventilatory threshold 1) en los varones y r=0.71 +/- 0.09 para el VT1 en las mujeres. La correlación más alta se observó para VT2 (ventilatory threshold 2): r= 0.78 +/- 0.04 (varones) y r= 0.79+/- 0.07 (mujeres). Los resultados muestran evidencia de la actividad central inspiratoria durante la transición aeróbica-anaeróbica, sugiriendo la validez del método propuesto (AU)


No disponible


Asunto(s)
Adulto , Femenino , Masculino , Humanos , Fenómenos Fisiológicos Respiratorios , Mecánica Respiratoria , Prueba de Esfuerzo/estadística & datos numéricos , Umbral Anaerobio/fisiología , Volumen de Ventilación Pulmonar/fisiología , Ejercicios Respiratorios , Esfuerzo Físico/fisiología , Capacidad Inspiratoria/fisiología , Flujo Espiratorio Máximo/fisiología
17.
Cardiovasc Drugs Ther ; 18(3): 219-24, 2004 May.
Artículo en Inglés | MEDLINE | ID: mdl-15229390

RESUMEN

AIM: To review whether brain natriuretic peptides (BNP) can be used as a surrogate for the traditional methods of assessing functional status in interventional studies of patients with left ventricular systolic dysfunction (LVSD). METHODS AND RESULTS: The traditional methods for assessing functional status including New York Heart Association (NYHA) class, exercise intolerance and quality of life were reviewed in relation to BNP measurements in patients with LVSD. A meta-analysis of four studies evaluating BNP levels versus exercise peak oxygen uptake or 6-minute walking distance showed a significant correlation, but a low R-value of -0.59. Studies using BNP levels for optimisation of heart failure therapy showed conflicting results concerning the correlation between the functional improvement and changes in BNP levels. Conflicting results were also found concerning the utility of BNP levels as a surrogate to predict efficacy of the various anti-congestive therapies on heart failure outcome. CONCLUSION: The results of the studies examining BNP measurement as a surrogate for functional status and drug efficacy in patients with LVSD are conflicting. Further studies are necessary to settle the place of BNP measurement as surrogate marker for exercise tolerance, NYHA classification and in assessing efficacy of different interventions in the clinical trials.


Asunto(s)
Biomarcadores/sangre , Estado de Salud , Péptido Natriurético Encefálico/sangre , Disfunción Ventricular Izquierda/diagnóstico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Carbazoles/uso terapéutico , Carvedilol , Ensayos Clínicos como Asunto/métodos , Ensayos Clínicos como Asunto/estadística & datos numéricos , Recolección de Datos/métodos , Esquema de Medicación , Enalapril/uso terapéutico , Prueba de Esfuerzo/métodos , Prueba de Esfuerzo/estadística & datos numéricos , Tolerancia al Ejercicio/fisiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Imidazolidinas/uso terapéutico , Metaanálisis como Asunto , Metoprolol/uso terapéutico , Péptido Natriurético Encefálico/química , Propanolaminas/uso terapéutico , Calidad de Vida , Estadística como Asunto , Resultado del Tratamiento , Disfunción Ventricular Izquierda/clasificación , Disfunción Ventricular Izquierda/fisiopatología
18.
J Appl Physiol (1985) ; 96(3): 943-50, 2004 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-14617526

RESUMEN

The purpose of this study was to examine the effects of caffeine (Caf) ingestion on pro- (PG) and macroglycogen (MG) resynthesis in 10 healthy men. Subjects completed two trials, consisting of a glycogen-depleting exercise, while ingesting either Caf or placebo capsules. Throughout recovery, biopsies were taken at 0 (exhaustion), 30, 120, and 300 min, and 75 g of carbohydrate were ingested at 0, 60, 120, 180, and 240 min. Whereas Caf ingestion resulted in a higher blood glucose concentration and decreased glycogen synthase fractional velocity (P

Asunto(s)
Cafeína/administración & dosificación , Carbohidratos de la Dieta/administración & dosificación , Glucógeno/biosíntesis , Esfuerzo Físico/efectos de los fármacos , Esfuerzo Físico/fisiología , Adulto , Análisis de Varianza , Suplementos Dietéticos , Método Doble Ciego , Prueba de Esfuerzo/estadística & datos numéricos , Humanos , Masculino , Factores de Tiempo
19.
Rev. Inst. Nac. Enfermedades Respir ; Rev. Inst. Nac. Enfermedades Respir;12(2): 87-96, abr.-jun. 1999. tab, graf
Artículo en Español | LILACS | ID: lil-254656

RESUMEN

Introducción. Si la cinética de VO2, VCO2, Ve y FC es influida por el tipo de actividad física, entonces el acondicionamiento deportivo de atletas mexicanos con especialidades distintas, pero VO2pico similar deberá mostrar correlación con la cinética cardiopulmonar. Material y métodos. Cuatro grupos del deporte de combate (COM=14), potencia (POT=8), conjunto (CON=10) y resistencia (RES=38); más uno de no atletas (NOA=19), realizaron una prueba ergométrica (creciente, rampa) de esfuerzo máximo, sentados en un cicloergómetro electrónico con respirometría de circuito abierto y a 2240 m de altitud. La respuesta cardiopulmonar fue modelada por computadora, mediante regresión lineal por el método de los mínimos cuadrados y su tiempo de respuesta media se usó de indicador cinético global. El ANOVA y en su caso el análisis post-hoc de Student-newman-Keuls permitió localizar diferencias significativas entre los valores promedio de antropometría general, signos vitales, respuesta máxima y tiempo de respuesta media de la dinámica cardiopulmonar entre grupos. Resultados. El grupo con menor acondicionamiento físico de resistencia fue el COM el cual mostró una cinética cardiopulmonar transitoria lenta durante el ejercicio ergométrico de tipo creciente. Conclusión. Existieron diferencias en la cinética de la respuesta holística de VO2, VCO2, Ve y FC durante el ejercicio ergométrico creciente entre grupos de deportistas, aun con VO2pico similar, atribuidas a distinto grado de adaptación fisicodeportiva de resistencia


Asunto(s)
Humanos , Masculino , Prueba de Esfuerzo , Prueba de Esfuerzo/estadística & datos numéricos , Frecuencia Cardíaca/fisiología , Cinética , Intercambio Gaseoso Pulmonar/fisiología , Deportes/fisiología , Deportes/estadística & datos numéricos , México
20.
Percept Mot Skills ; 88(1): 292-6, 1999 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-10214656

RESUMEN

While several studies have investigated the effects of music on cardiovascular endurance performance and perceived exertion during exercise of moderate intensity, few studies have investigated such effects on supramaximal exercise bouts. The purpose of the present study was to assess whether music affects performance on the Wingate Anaerobic Test. Each of the 12 men and 3 women were required to report to the laboratory on two occasions, once for tests in the music condition and once for tests in the nonmusic condition. Conditions were randomly ordered. All music selections were set at the same tempo. On each test day subjects performed a series of three Wingate Anaerobic Tests with 30-sec. rests in between. On Test 3 subjects were asked to continue pedaling until fatigued. Mean Power Output, Maximum Power Output, Minimum Power Output, and Fatigue Index were compared between conditions for each test using a repeated-measures analysis of variance. Time to fatigue on Trial 3 compared by analysis of variance gave no significant differences between conditions for any measures.


Asunto(s)
Prueba de Esfuerzo , Música , Resistencia Física/fisiología , Esfuerzo Físico/fisiología , Estimulación Acústica , Adulto , Anaerobiosis/fisiología , Análisis de Varianza , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Humanos , Masculino
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