Adverse Effects of Natural Products in the Oral Mucosa and Face: A Scoping Review.

Objective: This scoping review aimed to map the adverse reactions in the oral mucosa and face caused by the use of natural products. Methodology: This review was performed according to the Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, with a protocol registered in the Open Science Framework (DOI 10.17605/OSF.IO/R57D8). The search was carried out systematically using PubMed, Scopus, Web of Science, Embase, LILACS, and LIVIVO databases, as well as gray literature through Google Scholar and OpenGrey. Reports of clinical cases on the adverse effects of natural products on the oral mucosa or perioral region of the face resulted from inappropriate use or self-medication were included. Data from the included studies were described in a narrative form. Results: Seven hundred and six studies were identified, and after removing duplicates and applying the eligibility criteria, 28 studies were included. The year of publication ranged from 1976 to 2022. The studies were conducted in 19 countries. Fifty patients were mentioned in the included studies and 34 were female (68%). The natural products most related to adverse reactions were propolis (n = 17), with manifestations such as perioral eczema, edema, erosions, erythema, allergic contact dermatitis, and garlic (n = 9), with manifestations such as chemical burn, burning sensation, vesicles and blisters, crusts, and ulcerations. Conclusion: Propolis and garlic were the natural products with the most reported adverse effects on the oral mucosa and perioral region.

Modelos de preceptoria de residência em medicina de família e comunidade: um estudo Delphi / Models of preceptorship in family and community medicine residence: a Delphi study

Resumo Introdução: A preceptoria na atenção primária à saúde desempenha papel central na formação do residente, já que 70%-80% da carga horária dos programas de residência de medicina de família e comunidade (PRMFC) acontece na unidade de saúde da família. Como preceptor entende-se o professor que ensina na prática clínica. O cenário atual de expansão dos PRMFC, associado a poucos profissionais especializados em preceptoria, fez com que vários modelos fossem praticados. Uma revisão de literatura feita em estágio anterior a este trabalho, além das contribuições da Sociedade Brasileira de Medicina de Família e Comunidade, identificou quatro modelos de preceptoria em MFC: ombro a ombro, preceptor da equipe ao lado, preceptor de unidade e preceptor de campo. Objetivo: Este estudo teve como objetivos validar esses quatro modelos e identificar outros, determinar, sob a ótica da qualidade de formação dos residentes, a aceitabilidade e o grau de recomendação dos modelos, e reconhecer os pontos positivos e negativos. Método: Utilizou-se a técnica Delphi modificada por questionários on-line. O estudo começou com 24 participantes de todo o Brasil na primeira rodada e terminou com 18. Aplicaram-se a técnica de estatística descritiva e a análise de conteúdo. O estudo foi realizado entre fevereiro e abril de 2022. Resultado: Validaram-se os quatro modelos apresentados, e nenhum outro foi identificado. Os modelos ombro a ombro, preceptor da equipe ao lado e preceptor de unidade foram considerados aceitáveis; e o modelo preceptor de campo, inaceitável. Os modelos ombro a ombro e preceptor de unidade foram recomendados. Reconheceram-se 92 aspectos como pontos positivos e negativos, dos quais 81 atingiram consenso. Conclusão: Obteve-se a validação dos quatro tipos de modelos de preceptoria para PRMFC. Como os modelos ombro a ombro e preceptor de unidade foram elencados como aceitáveis e recomendáveis, é importante que sejam priorizados na implantação e manutenção dos PRMFC. Os modelos preceptor da equipe ao lado e preceptor de campo foram julgados como não recomendados e, portanto, devem ser evitados. O conhecimento das fortalezas e fraquezas de cada modelo prepara os PRMFC para as possíveis dificuldades e os auxilia na escolha do modelo adequado às diversas realidades existentes no país.

Abstract Introduction: Medical residency preceptorship in primary healthcare plays a major role in the professional qualification of medical residents, since 70-80% of the workload of the Family and Community Medical Residency Program (PRMFC) takes place in primary care clinics. A preceptor is understood as an experienced practitioner who teaches during clinical practice. The current scenario of expansion of PRMFCs in Brazil, associated with the limited number of professionals specialized in preceptorship, has resulted in the practice of different preceptorship models. A literature review performed in the previous stage of this study, added to the contributions of the Brazilian Society of Family and Community Medicine, pointed out four models of preceptorship in family practice: shoulder-to-shoulder, next-door team, clinic preceptor and field preceptor. Objective: To validate these four models of preceptorship and identify if there are others models; to determine, from the perspective of the quality of training residents, the acceptability and degree of recommendation of the models and recognize the positive and negative points. Method: The Delphi technique modified by online questionnaires was used. It was initiated with 24 participants from all over Brazil in the first round and ended with 18. Descriptive statistics and content analysis method was applied. The study was conducted between February and April 2022. Result: The four models presented were validated and no others were identified. The shoulder-to-shoulder, nextdoor team preceptor and clinic preceptor models were considered acceptable and the field preceptor model, unacceptable. The shoulder-to-shoulder and clinic preceptor models were recommended. Ninety-two aspects were recognized as positive and negative points. Of these, 81 achieved consensus. Conclusion: The shoulder-to-shoulder preceptor and clinic preceptor models were validated as acceptable and recommended, so it is important to prioritize these models in the implementation and maintenance of PRMFCs. The next-door team preceptor and field preceptor models were deemed as not recommended and, therefore, should be avoided. Information about the strengths and weaknesses of each model prepares the PRMFCs for possible implementation difficulties and helps them to select the appropriate model for the different realities existing in the country.

More than 10,000 pre-Columbian earthworks are still hidden throughout Amazonia.

Indigenous societies are known to have occupied the Amazon basin for more than 12,000 years, but the scale of their influence on Amazonian forests remains uncertain. We report the discovery, using LIDAR (light detection and ranging) information from across the basin, of 24 previously undetected pre-Columbian earthworks beneath the forest canopy. Modeled distribution and abundance of large-scale archaeological sites across Amazonia suggest that between 10,272 and 23,648 sites remain to be discovered and that most will be found in the southwest. We also identified 53 domesticated tree species significantly associated with earthwork occurrence probability, likely suggesting past management practices. Closed-canopy forests across Amazonia are likely to contain thousands of undiscovered archaeological sites around which pre-Columbian societies actively modified forests, a discovery that opens opportunities for better understanding the magnitude of ancient human influence on Amazonia and its current state.

Acute Effect of the "Zero Point" Method on Muscle Thickness and Muscle Damage in Trained Men.

The "zero point" method allows for lower intensities for an exercise session without impairing the total training volume. This study aimed to compare the effects of the "zero point" versus the traditional method on muscle responses and muscle damage in trained men. Fifteen experienced men (age: 27.7 ± 6.4 years; body mass: 78.4 ± 11.4 kg; height: 174.8 ± 4.9 cm; experience: 5.86 ± 4.7 years; relative bench press strength: 1.38 ± 0.17 kg·kg-1) were subjected to two exercise protocols in a randomized order and separated by a week. The traditional and "zero point" methods were applied in the bench press, with loads of 70% and 50% of one repetition maximum (1RM), respectively, for 10 sets until concentric failure, with 3-min intervals between sets. The zero point method displayed a higher number of repetitions and time under tension than the traditional method, with no difference in the total training volume, echo intensity, algometry, lactate, and myoglobin. For the muscle thickness, no differences between the groups were presented, except for the deltoid muscle thickness, in which a higher post-training volume was observed compared to traditional training. The "zero point" method increases the demand on the deltoid muscles in the bench press exercise, but not on the pectoralis and triceps brachii.

Manipulating Resistance Training Variables to Induce Muscle Strength and Hypertrophy: A Brief Narrative Review.

The regular practice of resistance training (RT) has been shown to induce relevant increases in both muscle strength and size. In order to maximize these adaptations, the proper manipulation of RT variables is warranted. In this sense, the aim of the present study was to review the available literature that has examined the application of the acute training variables and their influence on strength and morphological adaptations of healthy young adults. The information presented in this study may represent a relevant approach to proper training design. Therefore, strength and conditioning coaches may acquire a fundamental understanding of RT-variables and the relevance of their practical application within exercise prescription.

Tri-Set Training System Induces a High Muscle Swelling with Short Time Commitment in Resistance-Trained Subjects: A Cross-Over Study.

The purpose of the present study was to assess performance and morphological acute responses to the tri-set (TRI) resistance-training system. In a random order, 18 subjects (years: 30.0 ± 5.6; weight: 81.8 ± 13.4 kg; height: 173 ± 6.2 cm; RT experience: 4.6 ± 1.7 years) performed 3 exercises targeting the pectoralis major muscle in two different experimental conditions: traditional system (TRAD) and TRI. The TRAD protocol referred to the completion of a single exercise set followed by a rest period. For the TRI protocol, one set of each exercise was performed sequentially with a minimal rest interval afforded (< 10 seconds). Both protocols were performed in 3 sets of 10RM. Pectoralis major muscle swelling (PMMS), volume load (VL), internal training load (ITL) and training efficiency (TE) were calculated and compared between both protocols. Despite the low VL (-19.3%; p < 0.001), larger values of PMMS (104.7%; p < 0.001), ITL (24.3%; p < 0.001) and TE (56.0%; p < 0.001) were observed during TRI compared to TRAD condition. In conclusion, the adoption of a TRI training protocol may induce distinct performance and morphological acute responses compared to TRAD, suggesting that resistance-trained subjects may experience a higher muscle swelling and intensity of effort with short time commitment when performing TRI system.

Pre-exhaustion Training, a Narrative Review of the Acute Responses and Chronic Adaptations.

Pre-exhaustion (PE) is a popular resistance training strategy that involves performing a single-joint exercise followed by a multi-joint exercise with minimal recovery between the transition. This approach is widely used by bodybuilding athletes and resistance training (RT) enthusiasts with the aim of enhancing muscle strength and hypertrophy. The present paper aimed to provide a narrative review as to the effects of the PE method on different acute and chronic outcomes, and discuss relevant practical applications. When considering the body of literature as a whole, we conclude that current evidence does not support a benefit to the PE method compared to traditional RT models regarding chronic improvements in strength, hypertrophy and body composition. However, the heterogeneous study designs confound the ability to draw strong conclusions on the topic. Further investigations are warranted with strict control of study variables to better elucidate what, if any, benefits may be obtained by the PE method.

Residência de Medicina de Família e Comunidade: percepções de egressos sobre sua formação e processo de trabalho / Residencia de medicina de familia y comunidad: percepciones de egresados sobre su formación y proceso de trabajo / Family and Community Medicine Residency: graduates' insights about their education and work process

Analisou-se como as residências de Medicina de Família e Comunidade (RMFC) de uma capital da região norte do Brasil contribuíram para a formação e o desenvolvimento do atual processo de trabalho de seus egressos. Estudo exploratório, descritivo e transversal, com abordagem qualitativa focada em 31 egressos por meio de aplicação de questionário eletrônico com perguntas abertas. As respostas foram interpretadas por Análise de Conteúdo Temática, constituídas por quatro categorias empíricas: a formação em Medicina de Família e Comunidade (MFC) no processo de trabalho do egresso; reconhecimento e aplicação dos atributos da Atenção Primária à Saúde (APS); potências da formação em RMFC; e os desafios da especialidade. Os programas de RMFC estudados contribuem para a formação da prática profissional e do perfil dos seus egressos por meio do fortalecimento e da efetivação dos atributos da Atenção Primária à Saúde (APS), inclusive estendendo-se para além da especialidade.(AU)

Se analizó cómo las residencias de Medicina de Familia y Comunidad (RMFC) de una capital de la región Norte de Brasil contribuyeron en la formación y el desarrollo del actual proceso de trabajo de sus egresados. Estudio exploratorio, descriptivo y transversal, con abordaje cualitativo enfocado en 31 egresados por medio de la aplicación de cuestionario electrónico con preguntas abiertas. Las respuestas se interpretaron por Análisis de Contenido Temático, constituyéndose cuatro categorías empíricas: la formación en Medicina de Familia y Comunidad (MFC) en el proceso de trabajo del egresado; reconocimiento y aplicación de los tributos de la Atención Primaria de la Salud (APS); potencias de la formación en RMFC y los desafíos de la especialidad. Los programas de RMFC estudiados contribuyen con la formación de la práctica profesional y con el perfil de sus egresados por medio del fortalecimiento y puesta en práctica de los atributos de la APS, incluso ampliándose más allá de la especialidad.(AU)

The article analyzed how the Residency in Family and Community Medicine (RFCM) in a capital of the Northern region of Brazil contributed to the formation and development of the current work process of its graduates. This is an exploratory, descriptive and cross-sectional study, with a qualitative approach focused on 31 graduates, through electronic questionnaires with open questions. The answers were interpreted based on the Content Analysis Thematic technique, constituting four empirical categories: training in Family and Community Medicine (FCM) in the graduate's work process; recognition and application of the attributes of Primary Health Care (PHC); potentials of the FCM training and the challenges of the specialty. The analyzed data show that the studied Programs contribute to the education for professional practice and the profile of its graduates through the strengthening and implementation of the Primary Health Care (PHC) attributes, also extending beyond the specialty.(AU)

Rest-pause and drop-set training elicit similar strength and hypertrophy adaptations compared with traditional sets in resistance-trained males.

This paper aimed to compare the effect of drop-set (DS) and rest-pause (RP) systems versus traditional resistance training (TRT) with equalized total training volume on maximum dynamic strength (1RM) and thigh muscle thickness (MT). Twenty-eight resistance-trained males were randomly assigned to either RP (n = 10), DS (n = 9) or TRT (n = 9) protocols performed twice a week for 8 weeks. 1RM and MT of the proximal, middle and distal portions of the lateral thigh were assessed at baseline and post-intervention. A significant time × group interaction was observed for 1RM (P = 0.001) in the barbell back squat after 8-weeks. Post hoc comparisons revealed that RP promoted higher 1RM than TRT (P = 0.001); no statistical differences in strength were observed between the other conditions. A significant main effect of time was revealed for MT at the proximal (P = 0.0001) and middle (P = 0.0001) aspects of the lateral thigh for all training groups; however, the distal portion did not show a time effect (P = 0.190). There were no between-group interactions for MT. Our findings suggest that RP promotes slightly superior strength-related improvements compared with TRT, but hypertrophic adaptations are similar between conditions. Novelty: Rest-pause elicited a slightly superior benefit for strength adaptations compared with traditional resistance training. Resistance training systems do not promote superior hypertrophic adaptations when total training volume is equalized. Muscle thickness in distal portion of thigh is similar to baseline. Although modest, effect sizes tended to favor rest-pause.

Efeitos do treinamento de força com intensidade autosselecionada em paciente pós cirurgia bariátrica: um estudo de caso / Strenght training with self-selected intensity on a pacient post bariatric surgery

A prescrição de exercícios físicos em intensidades moderada e alta, para indivíduos obesos, pode induzir maiores percepções de desconforto/desprazer e, consequentemente, desencorajá-los a aderir a uma rotina de exercícios físicos. O objetivo deste trabalho foi investigar os efeitos de um programa de treinamento de força com intensidade autosselecionada, na composição corporal, hipertrofia e qualidade do sono de uma voluntária recémsubmetida a cirurgia bariátrica (idade: 28 anos; altura: 158cm; peso: 69 kg; índice de massa corporal: 27,64). A voluntária realizou um programa de treinamento de força com intensidade autosselecionada, pelo período de oito semanas (2 sessões semanais). Foi avaliada a qualidade de sono, por meio do questionário Pittsburgh sleep quality index; a composição corporal, por absorciometria de feixe duplo; e, a espessura muscular e do tecido adiposo, por ultrassonografia; antes e após a intervenção. Antes e após as sessões de treinamento, a percepção de prazer/desprazer foi mensurada com o auxílio de uma escala de valência afetiva. O programa de exercícios com intensidade autosselecionada resultou em uma diminuição de 2% no percentual de gordura, e de 7% na massa corporal total; sem modificação para a massa livre de gordura. Houve redução de 22% na espessura do tecido adiposo, e de 11% na espessura muscular do bíceps braquial; de 28% na espessura do tecido adiposo, e de 4% na espessura muscular do vasto lateral. A voluntária reportou percepção de prazer/desprazer positiva na maioria das sessões. No entanto, não houve diferença significativa entre os resultados para qualidade de sono. O treinamento com intensidade autosselecionada promoveu respostas positivas, relacionadas à percepção de prazer/desprazer, além de favorecer uma tendência à perda significativa de massa corporal total, sem prejuízos para a massa magra.(AU)

The prescription of physical exercise in moderate and high intensities for obese individuals may induce greater perceptions of discomfort/displeasure, consequently, decline adherence to a physical exercise routine. The objective of this study was investigate the effects of a strength training program with self-selected intensity, body composition, hypertrophy and sleep quality of a participant recently bariatric surgery (age: 28 years; height: 158cm; weight: 69 kg; body mass index: 27.64). The participant performed a strength training program with self-selection intensity, for a period of eight weeks (2 weekly sessions). Sleep quality was evaluated using the Pittsburgh sleep quality index questionnaire; body composition, by dual-energy x-ray absorptiometry, muscle and adipose tissue thickness by ultrasound. Each measure was before and after the intervention. Before and after the training sessions, the perception of pleasure/displeasure was measured with the affective valence scale. The exercise program with self-selected intensity resulted in a 2% decrease in fat percentage, and 7% in total body mass; without modification to the fat-free mass. Yet, there was a reduction of 22% in the thickness of adipose tissue, and 11% in the muscle thickness of the brachial biceps; 28% in the thickness of adipose tissue, and 4% in the muscle thickness of the vastus lateralis. The participant reported a perception of positive pleasure in most sessions. However, there was no significant difference between the results for sleep quality. The training with self-selected intensity promoted positive responses, related to the perception of pleasure/displeasure, besides promote a tendency to significant loss of total body mass, without damage to lean mass. (AU)

Carbohydrate refeed does not modify GVT-performance following energy restriction in bodybuilders.

Bodybuilding is a sport in which competitors' physiques are judged on their muscular size, symmetry, and leanness, as displayed in a number of different poses. In the pre-competitive period, bodybuilders attempt to reduce body fat stores as much as possible while maintaining fat-free mass (FFM). This is achieved via a sustained negative energy balance, generally induced by a combination of decreased energy intake and increased energy expenditure. This study aimed to assess the ability of bodybuilders to resist fatigue during resistance exercise based German Volume Training (GVT), as well as the affective response after carbohydrate refeed following four weeks of moderate or severe energy restriction. Eleven male bodybuilders (28.4 ± 2.3 years old) with experience in competitions were randomized into two groups: Moderate Energy Restriction (MER; n = 6) or Severe Energy Restriction (SER; n = 5). On the 2nd day (during energy restriction) and 7th day (during refeed) of the fourth week, both groups completed two leg press protocols involving the GVT method. After the first and last workout protocol subjects were assessed for muscle soreness using the visual-analog scale (VAS), rating of perceived exertion (RPE), affective response, lactate, and creatine kinase. Anthropometric analysis indicated that a reduction of 3.7 and 3.2% in body mass corresponded to a loss of 16.0 and 17.6% of fat mass for the MER and SER groups, respectively, with both groups maintaining FFM. Blood CK and VAS values were reduced only in SER. Our results suggest that a carbohydrate refeed may help to attenuate the perception of muscle soreness and maintain exercise performance, especially when severe energy restriction is combined with an intense training protocol such as GVT.

Case report of oral mucosa garlic burn during COVID-19 pandemic outbreak and role of teledentistry to manage oral health in an older adult woman.

BACKGROUND: The COVID-19 global pandemic and the uncertainty of an effective treatment protocol have resulted in fear and anxiety, which have increased the search for natural products to prevent the disease and to manage the symptoms. AIMS: To discuss the negative effects of garlic used as a preventive measure against the novel coronavirus. METHODS AND RESULTS: This study reports a case of oral mucosa burn on the dorsal surface of the tongue in a 72-year-old woman. The patient was using raw garlic daily during the pandemic to improve her immunological system. She scheduled a dental appointment and was assessed by teledentistry due to the pandemic, in which a detailed anamnesis was carried out. The burned area and ulceration were identified by video call and photographs. The patient was instructed to cease the habit immediately and change to a soft and non-acid/spicy/hot diet, which resulted in a great recovery 2 days later. She was monitored for 2 weeks until her tongue was completely healed. CONCLUSION: This case highlights the consequences of inappropriate use of natural product and how self-treatment could negatively influence oral health. Additionally, it shows the importance of teledentistry for oral diagnosis and treatment during a pandemic.

The impact of quarantine on body image and lifestyle habits in resistance training practitioners / Impacto da quarentena sobre a percepção da imagem corporal e hábitos dos praticantes de musculação / Impacto de la cuarentena sobre la percepción de la imagen corporaly hábitos de los practicantes de musculación

ABSTRACT Introduction In order to curb the abrupt advance of "Coronavirus Disease 2019" (COVID-19) and prevent the collapse of the health system, authorities around the world have opted for social distancing strategies that include closing gyms, among other measures. Objectives This study analyzed the effect of social distancing on resistance training practitioners' quality of life and perception of body image in silhouette. Methods The volunteers were contacted through social media; data were collected between April 13 and 19, 2020, through a structured questionnaire, comprised of an Informed Consent Form, four questions about COVID-19 and restrictive measures; and twenty-nine questions designed to characterize the individuals' habits; as well as the Short Form Health Survey 36 questionnaire. All the questionnaires were applied over the Internet, using Google Forms®. After collection, the data were tabulated and interpreted using the software program AppleNumbers®, and subsequently presented as mean, standard deviation and percentiles. Results The results revealed changes in perception of body image and decreased frequency and satisfaction with training. There was also an increase in sedentary behavior, food intake, and amount of sleep; and a reduction in parameters related to health and quality of life. Conclusions The strategy of social distancing, adopted to curb the progress of COVID-19, has harmful consequences for resistance training practitioners, such as increased calorie intake, stress and anxiety, as well as possible psychological effects. These consequences, in turn, lead to changes in self-perception of body image and in the quality of training. Level of Evidence III; Cross-sectional study of non-consecutive patients; without uniformly applied reference standard.

RESUMO Introdução Com o intuito de conter o avanço abrupto da "Coronavirus Disease 2019" (COVID-19) e evitar o colapso do sistema de saúde, autoridades mundiais optaram por estratégias de distanciamento social que compreendem o fechamento de academias, entre outras providências. Objetivos Este estudo analisou o efeito do distanciamento social sobre a qualidade de vida e a percepção da imagem corporal em silhueta de praticantes de treinamento de força. Métodos O contato com os voluntários foi realizado pelas mídias sociais e os dados foram coletados entre 13 e 19 de abril de 2020, por meio de um questionário estruturado, composto pelo Termo de consentimento livre e esclarecido, quatro questões sobre COVID-19 e medidas restritivas, vinte e nove questões destinadas à caracterização dos hábitos dos indivíduos, além do questionário Short Form Health Survey 36. Todos os questionários foram realizados no Google Forms®, com o auxílio da Internet. Depois da coleta, os dados foram tabulados e interpretados com o software AppleNumbers® e apresentados como média, desvio padrão e percentis. Resultados Os resultados revelaram alterações na percepção da imagem corporal, diminuição do volume e da satisfação com o treino. Ademais, foi observado um aumento do comportamento sedentário, da ingestão de alimentos e da quantidade de sono, além da redução dos parâmetros relacionados com a saúde e a qualidade de vida. Conclusões A estratégia de distanciamento social adotada para conter o avanço da COVID-19 revela consequências deletérias para os praticantes de treinamento de força, a saber, aumento da ingestão calórica, do estresse, da ansiedade, além de possíveis acometimentos de ordem psicológica. Essas consequências, por sua vez, promoveram alterações na percepção da autoimagem e na qualidade do treinamento. Nível de Evidência III; Estudo transversal de pacientes não consecutivos; sem padrão de referência aplicado uniformemente .

RESUMEN Introducción Con la intención de contener el avance abrupto de la "Coronavirus Disease 2019" (COVID-19) y evitar el colapso del sistema de salud, autoridades mundiales optaron por estrategias de distanciamiento social que comprenden el cierre de gimnasios, entre otras medidas. Objetivos Este estudio analizó el efecto del distanciamiento social sobre la calidad de vida y la percepción de la imagen corporal en silueta de practicantes de entrenamiento de fuerza. Métodos El contacto con los voluntarios fue realizado a través de las redes sociales y los datos fueron colectados entre el 13 y el 19 de abril de 2020, por medio de un cuestionario estructurado, compuesto por el Término de consentimiento libre y esclarecido, cuatro cuestiones sobre COVID-19 y medidas restrictivas, veintinueve cuestiones destinadas a la caracterización de los hábitos de los individuos, además del cuestionario Short Form Health Survey 36. Todos los cuestionarios fueron realizados en Google Forms®, con la ayuda de Internet. Después de la colecta, los datos fueron tabulados e interpretados con el software AppleNumbers® y presentados como promedio, desviación estándar y percentiles. Resultados Los resultados revelaron alteraciones en la percepción de la imagen corporal, disminución del volumen y de la satisfacción con el entrenamiento. Además, fue observado un aumento del comportamiento sedentario, de la ingestión de alimentos y de la cantidad de sueño; además de la reducción de los parámetros relacionados con la salud y la calidad de vida. Conclusiones La estrategia de distanciamiento social adoptada para contener el avance de la COVID-19 revela consecuencias deletéreas para los practicantes de entrenamiento de fuerza, tales como aumento de la ingestión calórica, estrés, ansiedad, además de posibles acometimientos de orden psicológico. Esas consecuencias, a su vez, promovieron alteraciones en la percepción de la autoimagen y en la calidad del entrenamiento. Nivel de evidencia III; Estudio transversal de pacientes no consecutivos; sin patrón de referencia aplicado uniformemente.

Training Programs Designed for Muscle Hypertrophy in Bodybuilders: A Narrative Review.

Bodybuilding is a sport that requires adequate training strategies in order to maximize skeletal muscle hypertrophy. The purpose of the present review was to perform a narrative assessment of the training routines designed for muscle hypertrophy used by bodybuilders. A search was carried out in the databases Pubmed/MEDLINE, Scielo, EBSCO, LILACS, SportDiscus, Web of Science, and CINAHL with the words "Resistance training" and "hypertrophy" in bodybuilders and their variations that involve the respective outcomes. Fourteen studies were identified that investigated the long-term training routines of bodybuilders. These studies demonstrate a pattern in the training organization, whereby there is a separation of training into four distinct periods: off-season, pre-contest, peak week, and post-contest. Each period has a specific spectrum of intensity load, total training volume, and exercise type (multi- or single-joint). We conclude that bodybuilding competitors employed a higher intensity load, lower number of repetitions, and longer rest intervals in the off-season than pre-contest.

Pre-stretching of the Hamstrings Before Squatting Acutely Increases Biceps Femoris Thickness Without Impairing Exercise Performance.

Background: Bilateral squat exercise is widely used in resistance training (RT) programs to increase lower limb strength and muscle mass, but this exercise does not result in significant hypertrophy of the hamstrings. It has been speculated that stretching between sets with a certain degree of tension results in muscle hypertrophy, while acute stretching could decrease performance during maximal contractions. Objective: This study investigated the acute effects of hamstring stretching before bilateral squatting on muscle thickness (MT), electromyography (EMG), and total training volume (TTV) on exercise performance. Methods: Fourteen resistance-trained young men, with ∼7.5 years of RT experience, performed the 10 repetition maximum (RM) for the barbell squat in two sessions (test-retest) separated by period after 48 h. Participants engaged in two resistance exercise conditions separated by a 1 week recovery interval: one session employed hamstrings stretching and the other did not include hamstrings stretching. Before and after each resistance exercise session, the thickness of the quadriceps muscles and biceps femoris long head were obtained by ultrasound imaging. Moreover, the EMG amplitudes for the quadriceps muscles, biceps femoris, and iliocostalis muscles were recorded during back squat performance. The TTV was also evaluated for each exercise session. Results: A significant increase in MT was observed after every set in both conditions for the evaluated quadriceps muscles (all p < 0.05), while for the biceps femoris, this effect was found only in the stretching condition (p < 0.05). EMG activity increased in the rectus femoris, vastus lateralis, and vastus medialis for the stretching condition. For the non-stretching condition, activity only increased in the vastus lateralis and medialis. There was no difference in EMG activity for the biceps femoris and iliocostalis in both conditions. Conclusion: Stretching the hamstrings immediately before each set of the back squat can be used to acutely increase biceps femoris thickness without impairing squat performance.

Reflections and proposals for the establishment of Family and Community Medicine Master's Programs in Brazil. / Reflexões e propostas para a estruturação de programas de Mestrado em Medicina de Família e Comunidade no Brasil.

While Primary Health Care (PHC) and Family and Community Medicine (FCM) have expanded their space and relevance in health care and undergraduate medical courses, Brazil has no stricto sensu FCM postgraduate programs. In this paper, we analyze some aspects of the Brazilian public health field and the national stricto sensu postgraduate system that can help to explain this scenario. As a contribution to the debate on this topic, we also gathered information from international postgraduate and research experiences in FCM and devised a curriculum proposal for future national FCM master's courses. In the end, we discussed some key strategies for the emergence of stricto sensu postgraduate courses in this discipline in Brazil, highlighting the potential of these programs for evaluation and qualification of primary care services, especially the Family Health Strategy, and the training of PHC specialists required for the consolidation of the Unified Health System (SUS) as an accessible, comprehensive and equitable health system for the Brazilian population.

Embora a atenção primária à saúde (APS) e a medicina de família e comunidade (MFC) tenham aumentado seu espaço e relevância no cenário assistencial e nos cursos de graduação médica, não há cursos de pós-graduação "stricto sensu" em MFC no Brasil. Neste artigo, analisamos alguns aspectos do campo da saúde pública brasileira e da própria estruturação da pós-graduação "stricto sensu" nacional que podem ajudar a explicar este panorama. Como uma contribuição para o debate neste tema, também reunimos informações de experiências internacionais em pós-graduação e pesquisa em MFC e elaboramos uma proposta de currículo para futuros cursos nacionais de mestrado em MFC. Ao final discutimos algumas estratégias fundamentais para o surgimento de cursos de pós-graduação "stricto sensu" nesta área no Brasil, destacando o potencial desses cursos para a avaliação e a qualificação dos serviços de atenção primária, em especial a Estratégia Saúde da Família, e para a formação de profissionais especializados em APS necessários para a consolidação do Sistema Único de Saúde como sistema acessível, abrangente e equitativo para a população brasileira.

Reflexões e propostas para a estruturação de programas de Mestrado em Medicina de Família e Comunidade no Brasil / Reflections and proposals for the establishment of Family and Community Medicine Master's Programs in Brazil

Resumo Embora a atenção primária à saúde (APS) e a medicina de família e comunidade (MFC) tenham aumentado seu espaço e relevância no cenário assistencial e nos cursos de graduação médica, não há cursos de pós-graduação "stricto sensu" em MFC no Brasil. Neste artigo, analisamos alguns aspectos do campo da saúde pública brasileira e da própria estruturação da pós-graduação "stricto sensu" nacional que podem ajudar a explicar este panorama. Como uma contribuição para o debate neste tema, também reunimos informações de experiências internacionais em pós-graduação e pesquisa em MFC e elaboramos uma proposta de currículo para futuros cursos nacionais de mestrado em MFC. Ao final discutimos algumas estratégias fundamentais para o surgimento de cursos de pós-graduação "stricto sensu" nesta área no Brasil, destacando o potencial desses cursos para a avaliação e a qualificação dos serviços de atenção primária, em especial a Estratégia Saúde da Família, e para a formação de profissionais especializados em APS necessários para a consolidação do Sistema Único de Saúde como sistema acessível, abrangente e equitativo para a população brasileira.

Abstract While Primary Health Care (PHC) and Family and Community Medicine (FCM) have expanded their space and relevance in health care and undergraduate medical courses, Brazil has no stricto sensu FCM postgraduate programs. In this paper, we analyze some aspects of the Brazilian public health field and the national stricto sensu postgraduate system that can help to explain this scenario. As a contribution to the debate on this topic, we also gathered information from international postgraduate and research experiences in FCM and devised a curriculum proposal for future national FCM master's courses. In the end, we discussed some key strategies for the emergence of stricto sensu postgraduate courses in this discipline in Brazil, highlighting the potential of these programs for evaluation and qualification of primary care services, especially the Family Health Strategy, and the training of PHC specialists required for the consolidation of the Unified Health System (SUS) as an accessible, comprehensive and equitable health system for the Brazilian population.

Chagas disease is associated with a poor outcome at 1-year follow-up after cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is a therapeutic modality for patients with heart failure (HF). The effectiveness of this treatment for event reduction is based on clinical trials where the population of patients with Chagas' disease (DC) is underrepresented. OBJECTIVE: To evaluate the prognosis after CRT of a population in which CD is an endemic cause of HF. METHODS: A retrospective cohort conducted between January 2015 and December 2016 that included patients with HF and left ventricular ejection fraction (LVEF) of less than 35% and undergoing CRT. Clinical and demographic data were collected to search for predictors for the combined outcome of death or hospitalization for HF at one year after CRT implantation. RESULTS: Fifty-four patients were evaluated, and 13 (24.1%) presented CD as the etiology of HF. The mean LVEF was 26.2± 6.1%, and 36 (66.7%) patients presented functional class III or IV HF. After the mean follow-up of 15 (±6,9) months, 17 (32.1%) patients presented the combined outcome. In the univariate analysis, CD was associated with the combined event when compared to other etiologies of HF, 8 (47%) vs. 9 (13,5%), RR: 3,91 CI: 1,46-10,45, p=0,007, as well as lower values of LVEF. In the multivariate analysis, CD and LVEF remained independent risk factors for the combined outcome. CONCLUSION: In a population of HF patients undergoing CRT, CD was independently associated with mortality and hospitalization for HF.

Effects of Pre-exhaustion Versus Traditional Resistance Training on Training Volume, Maximal Strength, and Quadriceps Hypertrophy.

BACKGROUND: The pre-exhaustion (PreEx) method is used as a resistance training (RT) method to increase muscle mass, yet the chronic effects of this method are poorly understood. OBJECTIVE: Although readily prescribed as a RT method for promotion of muscle hypertrophy, few researches give light to gains made after chronic PreEx RT. Therefore, we compared the effects of traditional versus PreEx RT programs on muscle strength, body composition, and muscular hypertrophy in adult males. METHODS: Untrained subjects (age: 31.37 ± 6.83 years; height: 175.29 ± 5.52 cm; body mass: 82.04 ± 13.61 kg; 1RM leg press: 339.86 ± 61.17 kg; 1RM leg extension: 121.71 ± 11.93 kg) were submitted to 9 weeks of RT with weekly sessions. Traditional (TRT) group (n = 12) performed three sets at 45° of leg press exercise at 75% of 1RM, PreEx group (n = 12) completed a set to failure on a leg extension machine prior to the leg press, and the control (CON) group (n = 7) did not train. Maximum strength, muscle thickness, and body composition were analyzed. RESULTS: PreEx group increased in maximal strength on leg press (16 ± 8%) and leg extension (17 ± 11%), while the TRT group improved by 15 ± 9 and 11 ± 4%, respectively. The thickness of the quadriceps muscles increased for both intervention groups. Specifically, the post-training thickness of the vastus lateralis was significantly higher for PreEx (55%) compared to the CON group. The TRT group presented a greater loss of total and thigh fat mass when compared with the PreEx method. These results were found in the presence of a lower training load for the PreEx group. CONCLUSION: The PreEx training can decrease the total training volume while maintaining results in strength and hypertrophy when comparing to TRT. However, TRT may be optimal if the goal is to decrease fat mass.

Chagas disease is associated with a poor outcome at 1-year follow-up after cardiac resynchronization therapy

SUMMARY BACKGROUND: Cardiac resynchronization therapy (CRT) is a therapeutic modality for patients with heart failure (HF). The effectiveness of this treatment for event reduction is based on clinical trials where the population of patients with Chagas' disease (DC) is underrepresented. OBJECTIVE: To evaluate the prognosis after CRT of a population in which CD is an endemic cause of HF. METHODS: A retrospective cohort conducted between January 2015 and December 2016 that included patients with HF and left ventricular ejection fraction (LVEF) of less than 35% and undergoing CRT. Clinical and demographic data were collected to search for predictors for the combined outcome of death or hospitalization for HF at one year after CRT implantation. RESULTS: Fifty-four patients were evaluated, and 13 (24.1%) presented CD as the etiology of HF. The mean LVEF was 26.2± 6.1%, and 36 (66.7%) patients presented functional class III or IV HF. After the mean follow-up of 15 (±6,9) months, 17 (32.1%) patients presented the combined outcome. In the univariate analysis, CD was associated with the combined event when compared to other etiologies of HF, 8 (47%) vs. 9 (13,5%), RR: 3,91 CI: 1,46-10,45, p=0,007, as well as lower values of LVEF. In the multivariate analysis, CD and LVEF remained independent risk factors for the combined outcome. CONCLUSION: In a population of HF patients undergoing CRT, CD was independently associated with mortality and hospitalization for HF.

RESUMO INTRODUÇÃO: A terapia de ressincronização cardíaca (TRC) é uma modalidade terapêutica para pacientes com insuficiência cardíaca (IC). A eficácia desse tratamento para redução de eventos baseia-se em ensaios clínicos em que a população de pacientes com doença de Chagas (DC) é sub-representada. OBJETIVO: Avaliar o prognóstico após TRC em uma população em que a DC é uma causa frequente de IC. MÉTODOS: Coorte retrospectiva realizada entre janeiro de 2015 e dezembro de 2016, sendo incluídos pacientes portadores de IC com fração de ejeção do ventrículo esquerdo (Feve) menor que 35% e submetidos à TRC. Os dados clínicos e demográficos foram coletados para pesquisa de preditores para o desfecho combinado de morte ou internação por IC após implante da TRC. RESULTADOS: Foram avaliados 54 pacientes, dos quais 13 (24,1%) apresentavam a DC como etiologia da IC. A Feve média foi de 26,2% (±6,1) e 36 (66,7%) pacientes apresentavam classe funcional de IC III ou IV. Após o seguimento médio de 15 meses, 17 (32,1%) pacientes apresentaram o desfecho combinado. Na análise univariada, a DC esteve associada ao evento combinado quando comparada a outras etiologias de IC, 8 (47%) vs 9 (13,5%), RR: 3,91 IC: 1,46-10,45, p=0,007, assim como valores mais baixos da Feve. Na análise multivariada, a DC e a Feve permaneceram como fatores de risco independentes para o desfecho combinado. CONCLUSÃO: Em uma população de pacientes com IC submetidos à TRC, a doença de Chagas esteve independentemente associada à mortalidade e internação por insuficiência cardíaca no seguimento de 15 meses.