On the use of fractional calculus to improve the pulse arrival time (PAT) detection when using photoplethysmography (PPG) and electrocardiography (ECG) signals.

The pulse arrival time (PAT) has been considered a surrogate measure for pulse wave velocity (PWV), although some studies have noted that this parameter is not accurate enough. Moreover, the inter-beat interval (IBI) time series obtained from successive pulse wave arrivals can be employed as a surrogate measure of the RR time series avoiding the use of electrocardiogram (ECG) signals. Pulse arrival detection is a procedure needed for both PAT and IBI measurements and depends on the proper fiducial points chosen. In this paper, a new set of fiducial points that can be tailored using several optimization criteria is proposed to improve the detection of successive pulse arrivals. This set is based on the location of local maxima and minima in the systolic rise of the pulse wave after fractional differintegration of the signal. Several optimization criteria have been proposed and applied to high-quality recordings of a database with subjects who were breathing at different rates while sitting or standing. When a proper fractional differintegration order is selected by using the RR time series as a reference, the agreement between the obtained IBI and RR is better than that for other state-of-the-art fiducial points. This work tested seven different traditional fiducial points. For the agreement analysis, the median standard deviation of the difference between the IBI and RR time series is 5.72 ms for the proposed fiducial point versus 6.20 ms for the best-performing traditional fiducial point, although it can reach as high as 9.93 ms for another traditional fiducial point. Other optimization criteria aim to reduce the standard deviation of the PAT (7.21 ms using the proposed fiducial point versus 8.22 ms to 15.4 ms for the best- and worst-performing traditional fiducial points) or to minimize the standard deviation of the PAT attributable to breathing (3.44 ms using the proposed fiducial point versus 4.40 ms to 5.12 ms for best- and worst-performing traditional fiducial points). The use of these fiducial points may help to better quantify the beat-to-beat PAT variability and IBI time series.

A Serious Game to Self-Regulate Heart Rate Variability as a Technique to Manage Arousal Level Through Cardiorespiratory Biofeedback: Development and Pilot Evaluation Study.

BACKGROUND: Heart rate variability biofeedback (HRVB) is an established intervention for increasing heart rate variability (HRV) in the clinical context. Using this technique, participants become aware of their HRV through real-time feedback and can self-regulate it. OBJECTIVE: The aim of this study was 2-fold: first, to develop a serious game that applies the HRVB technique to teach participants to self-regulate HRV and, second, to test the app with participants in a pilot study. METHODS: An HRVB app called the FitLab Game was developed for this study. To play the game, users must move the main character up and down the screen, avoiding collisions with obstacles. The wavelength that users must follow to avoid these obstacles is based on the user's basal heart rate and changes in instantaneous heart rate. To test the FitLab Game, a total of 16 participants (mean age 23, SD 0.69 years) were divided into a control group (n=8) and an experimental group (n=8). A 2 × 2 factorial design was used in each session. Participants in the experimental condition were trained in breathing techniques. RESULTS: Changes in the frequency and time domain parameters of HRV and the game's performance features were evaluated. Significant changes in the average RR intervals and root mean square of differences between adjacent RR intervals (RMSSD) were found between the groups (P=.02 and P=.04, respectively). Regarding performance, both groups showed a tendency to increase the evaluated outcomes from baseline to the test condition. CONCLUSIONS: The results may indicate that playing different levels leads to an improvement in the game's final score by repeated training. The tendency of changes in HRV may reflect a higher activation of the mental system of attention and control in the experimental group versus the control group. In this context, learning simple, voluntary strategies through a serious game can aid the improvement of self-control and arousal management. The FitLab Game appears to be a promising serious game owing to its ease of use, high engagement, and enjoyability provided by the instantaneous feedback.

Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines.

Heart Rate Variability Biofeedback (HRVB) has been widely used to improve cardiovascular health and well-being. HRVB is based on breathing at an individual's resonance frequency, which stimulates respiratory sinus arrhythmia (RSA) and the baroreflex. There is, however, no methodological consensus on how to apply HRVB, while details about the protocol used are often not well reported. Thus, the objectives of this systematic review are to describe the different HRVB protocols and detect methodological concerns. PsycINFO, CINALH, Medline and Web of Science were searched between 2000 and April 2021. Data extraction and quality assessment were based on PRISMA guidelines. A total of 143 studies were finally included from any scientific field and any type of sample. Three protocols for HRVB were found: (i) "Optimal RF" (n = 37), each participant breathes at their previously detected RF; (ii) "Individual RF" (n = 48), each participant follows a biofeedback device that shows the optimal breathing rate based on cardiovascular data in real time, and (iii) "Preset-pace RF" (n = 51), all participants breathe at the same rate rate, usually 6 breaths/minute. In addition, we found several methodological differences for applying HRVB in terms of number of weeks, duration of breathing or combination of laboratory and home sessions. Remarkably, almost 2/3 of the studies did not report enough information to replicate the HRVB protocol in terms of breathing duration, inhalation/exhalation ratio, breathing control or body position. Methodological guidelines and a checklist are proposed to enhance the methodological quality of future HRVB studies and increase the information reported.

Could hand-eye laterality profiles affect sport performance? A systematic review.

Background: Laterality effects on sports performance have been a field of interest for the sports sciences, especially in asymmetrical sports, which require the preferential use of one side of the body. Some sports in particular involve the visual system and ocular laterality, due to the need to clearly focus on a dynamic object (ball, opponent, projectile, etc.). The relationship between manual and ocular laterality results in two perceptual-motor profiles, one where the dominant hand and eye are ipsilateral (uncrossed hand-eye laterality profile, UC-HELP), and the other where they are contralateral (crossed hand-eye laterality profile, C-HELP). Methodology: A systematic review of the literature was carried out to determine the prevalence of hand-eye laterality profiles in the different sports modalities and their relationship with psychological factors and sports performance. Searches of PsycInfo, Medline, Scopus and grey literature identified 14 studies (2,759 participants) regarding hand-eye laterality in sports that met the eligibility criteria. Results: Previous studies have estimated that between 10-30% of the general population exhibit a C-HELP, and 70-90% have an UC-HELP. The results of the reviewed studies indicate that in some sports the percentage of C-HELP is higher in regular and high-level athletes than in the normal population: golf (52.55%), soccer (53%), tennis (42%) and team sports (50.7%). In target sports (archery and shooting) athletes with an UC-HELP seem to have an advantage given the significant concentration of this profile in the highest performing populations (82.3%). In basketball, cricket and golf, the literature reviewed also reported biomechanical differences in the execution of some techniques between the two profiles. We did not find any study in our review that related hand-eye laterality with cognitive, tactical, or psychological aspects of athletes. Conclusions: These results should be taken with great caution due to the potential bias linked to the methodologies used in the investigations, the heterogeneity in the assessment of hand-eye laterality, the few studies available on the subject and the indirect nature of many of the observed relationships between performance and laterality. For further investigation, we propose a standardized terminology and protocol of hand-eye laterality assessment in sports. The advancement in knowledge about hand-eye laterality profiles, along with the study of the relationship with psychological or tactical-sports patterns, can contribute to more effective development plans for athletes and can be a complement to talent detection.

Quantity and quality of sleep in young players of a professional football club.

PURPOSE: To investigate the quantity and quality of sleep hours in young athletes in a professional football club, to study if there is a significant relationship with mood state and subjective well-being, and to identify the relationship between sleep and quarterly academic performance. We also explored the relationship between sleep and quarterly academic performance. METHOD: the study included 261 players of the various age group categories from football at Barcelona Football Club (average age:13.04 ± 3.16). Participants maintained a sleep diary and completed questionnaires on their mood state and the quantity and quality of their sleep. RESULTS: 70% of the athletes slept less hours than recommended by the American National Sleep Foundation. Athletes with worse quantity and quality of sleep showed negative effects on academic results. CONCLUSIONS: The results show that the majority of young players sleep less than recommended and show that those who sleep more hours obtain better academic results.

Agreement between two photoplethysmography-based wearable devices for monitoring heart rate during different physical activity situations: a new analysis methodology.

Wearables are being increasingly used to monitor heart rate (HR). However, their usefulness for analyzing continuous HR in research or at clinical level is questionable. The aim of this study is to analyze the level of agreement between different wearables in the measurement of HR based on photoplethysmography, according to different body positions and physical activity levels, and compared to a gold-standard ECG. The proposed method measures agreement among several time scales since different wearables obtain HR at different sampling rates. Eighteen university students (10 men, 8 women; 22 ± 2.45 years old) participated in a laboratory study. Participants simultaneously wore an Apple Watch and a Polar Vantage watch. ECG was measured using a BIOPAC system. HR was recorded continuously and simultaneously by the three devices, for consecutive 5-min periods in 4 different situations: lying supine, sitting, standing and walking at 4 km/h on a treadmill. HR estimations were obtained with the maximum precision offered by the software of each device and compared by averaging in several time scales, since the wearables obtained HR at different sampling rates, although results are more detailed for 5 s and 30 s epochs. Bland-Altman (B-A) plots show that there is no noticeable difference between data from the ECG and any of the smartwatches while participants were lying down. In this position, the bias is low when averaging in both 5 s and 30 s. Differently, B-A plots show that there are differences when the situation involves some level of physical activity, especially for shorter epochs. That is, the discrepancy between devices and the ECG was greater when walking on the treadmill and during short time scales. The device showing the biggest discrepancy was the Polar Watch, and the one with the best results was the Apple Watch. We conclude that photoplethysmography-based wearable devices are suitable for monitoring HR averages at regular intervals, especially at rest, but their feasibility is debatable for a continuous analysis of HR for research or clinical purposes, especially when involving some level of physical activity. An important contribution of this work is a new methodology to synchronize and measure the agreement against a gold standard of two or more devices measuring HR at different and not necessarily even paces.

Heart rate variability, mood and performance: a pilot study on the interrelation of these variables in amateur road cyclists.

Objective: The present study seeks to explore the relationship between measures of cycling training on a given day and the heart rate variability (HRV) and mood states obtained the following morning. The association between HRV and mood state is also studied, as is the relationship between internal and external measures of training. Methods: During a 6-week period, five recreational road cyclists collected 123 recordings of morning HRV and morning mood, and 66 recordings of training power and rate of perceived exertion (RPE). Training power was used as an external measure of performance and RPE as an internal measure of performance. The HRV parameters used in the study were the mean of RR intervals (mean RR) and the standard deviation of all RR intervals (SDNN) as time domain analysis, and the normalized high frequency band (HFnu), normalized low frequency band (LFnu) and the ratio between low and high frequency bands, as frequency domain analysis. Mood was measured using a 10-point cognitive scale. Results: It was found that the higher the training power on a given day, the lower the HFnu and the higher LF/HF were on the following morning. At the same time, results showed an inverse relationship between training and mood, so the tougher a training session, the lower the mood the following day. A relationship between morning HRV and mood was also found, so that the higher mean RR and HFnu, the more positive the mood (r = 0.497 and r = 0.420 respectively; p < 0.001). Finally, RPE correlated positively with external power load variables (IF: r = 0.545; p < 0.001). Conclusion: Altogether, the results indicate a relationship between training of cyclists on a given day and their morning HRV and mood state on the following day. Mood and HRV also seem positively related. It is argued that developing a monitoring system that considers external and internal training loads, together with morning mood, could help understand the state of the individual, enabling feedback to athletes to facilitate the adaptation to training and to prevent problems associated with overtraining. However, more research is needed to further understand the association between the different variables considered.

Evaluation of cognitive load in team sports: literature review.

In team sports, load management has become one of the most common areas of investigation, given that effective control over load is the key to being able to optimize performance and avoid injuries. Despite the constant evolution and innovation in the latest theories, we can see a clear tendency in load management that focuses on physiological and mechanical aspects and neglects its cognitive character, which generates the variability inherent in the performance of athletes in a changing environment. Indicators of response that inform methods of control over cognitive load can include cognitive, physiological and behavioral indicators. However, limited investigations exist to support the reliability of each indicator regarding cognitive load. For this reason, the objective of this literature review is to present strategies used to manage cognitive load in team sports, as well as the indicators utilized for such a proposition and their relationships in specific contexts.

Analysis of Gender Differences in HRV of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Using Mobile-Health Technology.

In a previous study using mobile-health technology (mHealth), we reported a robust association between chronic fatigue symptoms and heart rate variability (HRV) in female patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This study explores HRV analysis as an objective, non-invasive and easy-to-apply marker of ME/CFS using mHealth technology, and evaluates differential gender effects on HRV and ME/CFS core symptoms. In our methodology, participants included 77 ME/CFS patients (32 men and 45 women) and 44 age-matched healthy controls (19 men and 25 women), all self-reporting subjective scores for fatigue, sleep quality, anxiety, and depression, and neurovegetative symptoms of autonomic dysfunction. The inter-beat cardiac intervals are continuously monitored/recorded over three 5-min periods, and HRV is analyzed using a custom-made application (iOS) on a mobile device connected via Bluetooth to a wearable cardiac chest band. Male ME/CFS patients show increased scores compared with control men in all symptoms and scores of fatigue, and autonomic dysfunction, as with women in the first study. No differences in any HRV parameter appear between male ME/CFS patients and controls, in contrast to our findings in women. However, we have found negative correlations of ME/CFS symptomatology with cardiac variability (SDNN, RMSSD, pNN50, LF) in men. We have also found a significant relationship between fatigue symptomatology and HRV parameters in ME/CFS patients, but not in healthy control men. Gender effects appear in HF, LF/HF, and HFnu HRV parameters. A MANOVA analysis shows differential gender effects depending on the experimental condition in autonomic dysfunction symptoms and HF and HFnu HRV parameters. A decreased HRV pattern in ME/CFS women compared to ME/CFS men may reflect a sex-related cardiac autonomic dysfunction in ME/CFS illness that could be used as a predictive marker of disease progression. In conclusion, we show that HRV analysis using mHealth technology is an objective, non-invasive tool that can be useful for clinical prediction of fatigue severity, especially in women with ME/CFS.

Resonance frequency is not always stable over time and could be related to the inter-beat interval.

Heart Rate Variability Biofeedback (HRVB) is based on breathing at an optimal rate (or resonance frequency, RF) corresponding to the respiratory sinus arrhythmia (RSA). Our aim is to check whether the RF is a stable factor and analyse the HRV parameters individually per each breathing rate, comparing it with free slow breathing. A sample of 21 participants were trained in a test-retest HRVB protocol. The results indicated that RF changed between Test and Retest sessions in 66.7% of participants. This instability could be related to the average of interbeat interval (IBI). HRV time domain parameters (SDNN and RMSSD) were significantly higher for RF than for other breathing rates, including 6 breath/min and free slow breathing. Free slow breathing showed a lower heart rate averages than RF and other slow breathing rates. Overall, our study suggests the relevance of assessing RF individually and before each HRVB session, because the maximum cardiovascular benefits in terms of increasing HRV were found only at RF. Thus, breathing at the individualized and momentary frequency of resonance increases cardiac variability.

Can HRV Biofeedback Improve Short-Term Effort Recovery? Implications for Intermittent Load Sports.

As intensity and physical demands continue to rise in sport competition, faster and better recovery becomes essential. The aim of this study was to assess the effects of HRV biofeedback (HRVB) while recovering from a submaximal aerobic exercise. Ten physically-active graduate students participated in the study, which was conducted in four sessions: exercise with free-breathing recovery, first resonance frequency (RF) detection, second RF detection, and exercise applying HRVB during recovery. Measurements included time spent running and recovering, HRV parameters, and recovery/exertion perceptions. The results indicate that using HRVB during recovery improves cardiac variability (RRmean, SDNN, RMSSD and LF; p < 0.01). HRVB also lowers recovery time (p < 0.05) and seems to be improving the perception of recovery (p = 0.087). Moreover, time spent exercising (p < 0.01) and perceived physical exertion (p < 0.05) were higher when applying HRVB. The improvement in the psychophysiological adaptation after intensive aerobic exercise provided by the HRVB is a valuable benefit, not only for competition-driven athletes, but also for the general population.

mHealth technology for ecological momentary assessment in physical activity research: a systematic review.

OBJECTIVE: To systematically review the publications on ecological momentary assessment (EMA) relating to physical activity (PA) behavior in order to classify the methodologies, and to identify the main mHealth technology-based tools and procedures that have been applied during the first 10 years since the emergence of smartphones. As a result of this review, we want to ask if there is enough evidence to propose the use of the term "mEMA" (mobile-based EMA). DESIGN: A systematic review according to PRISMA Statement (PROSPERO registration: CRD42018088136). METHOD: Four databases (PsycINFO, CINALH, Medline and Web of Science Core Collection) were searched electronically from 2008 to February 2018. RESULTS: A total of 76 studies from 297 potential articles on the use of EMA and PA were included in this review. It was found that 71% of studies specifically used "EMA" for assessing PA behaviors but the rest used other terminology that also adjusted to the inclusion criteria. Just over half (51.3%) of studies (39) used mHealth technology, mainly smartphones, for collecting EMA data. The majority (79.5%) of these studies (31 out of 39) were published during the last 4 years. On the other hand, 58.8% of studies that only used paper-and-pencil were published during the first 3 years of the 10-year period analyzed. An accelerometer was the main built-in sensor used for collecting PA behavior by means of mHealth (69%). Most of the studies were carried out on young-adult samples, with only three studies in older adults. Women were included in 60% of studies, and healthy people in 82%. The studies lasted between 1 and 7 days in 57.9%, and between three and seven assessments per day were carried out in 37%. The most popular topics evaluated together with PA were psychological state and social and environmental context. CONCLUSIONS: We have classified the EMA methodologies used for assessing PA behaviors. A total of 71% of studies used the term "EMA" and 51.3% used mHealth technology. Accelerometers have been the main built-in sensor used for collecting PA. The change of trend in the use of tools for EMA in PA coincides with the technological advances of the last decade due to the emergence of smartphones and mHealth technology. There is enough evidence to use the term mEMA when mHealth technology is being used for monitoring real-time lifestyle behaviors in natural situations. We define mEMA as the use of mobile computing and communication technologies for the EMA of health and lifestyle behaviors. It is clear that the use of mHealth is increasing, but there is still a lot to be gained from taking advantage of all the capabilities of this technology in order to apply EMA to PA behavior. Thus, mEMA methodology can help in the monitoring of healthy lifestyles under both subjective and objective perspectives. The tendency for future research should be the automatic recognition of the PA of the user without interrupting their behavior. The ecological information could be completed with voice messages, image captures or brief text selections on the touch screen made in real time, all managed through smartphone apps. This methodology could be extended when EMA combined with mHealth are used to evaluate other lifestyle behaviors.

Reduced heart rate variability predicts fatigue severity in individuals with chronic fatigue syndrome/myalgic encephalomyelitis.

BACKGROUND: Heart rate variability (HRV) is an objective, non-invasive tool to assessing autonomic dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). People with CFS/ME tend to have lower HRV; however, in the literature there are only a few previous studies (most of them inconclusive) on their association with illness-related complaints. To address this issue, we assessed the value of different diurnal HRV parameters as potential biomarker in CFS/ME and also investigated the relationship between these HRV indices and self-reported symptoms in individuals with CFS/ME. METHODS: In this case-control study, 45 female patients who met the 1994 CDC/Fukuda definition for CFS/ME and 25 age- and gender-matched healthy controls underwent HRV recording-resting state tests. The intervals between consecutive heartbeats (RR) were continuously recorded over three 5-min periods. Time- and frequency-domain analyses were applied to estimate HRV variables. Demographic and clinical features, and self-reported symptom measures were also recorded. RESULTS: CFS/ME patients showed significantly higher scores in all symptom questionnaires (p < 0.001), decreased RR intervals (p < 0.01), and decreased HRV time- and frequency-domain parameters (p < 0.005), except for the LF/HF ratio than in the healthy controls. Overall, the correlation analysis reached significant associations between the questionnaires scores and HRV time- and frequency-domain measurements (p < 0.05). Furthermore, separate linear regression analyses showed significant relationships between self-reported fatigue symptoms and mean RR (p = 0.005), RMSSD (p = 0.0268) and HFnu indices (p = 0.0067) in CFS/ME patients, but not in healthy controls. CONCLUSIONS: Our findings suggest that ANS dysfunction presenting as increased sympathetic hyperactivity may contribute to fatigue severity in individuals with ME/CFS. Further studies comparing short- and long-term HRV recording and self-reported outcome measures with previous studies in larger CFS/ME cohorts are urgently warranted.

La longitud del tendón libre no está asociada al tiempo de vuelta a la competición en las lesiones musculares del bíceps femoral / Length of the free tendon is not associated with return to play time in biceps femoris muscle injuries / La longitud del tendó lliure no està associada al temps de retorn a la competició en les lesions musculars del bíceps femoral

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The Hidden Sufferers: Parental Reactions to Childhood Cancer during Treatment and at Survival.

This study was twofold: 1) to assess parental reactions to childhood cancer throughout the oncological experience and 2) to explore associations between parents' reactions during treatment and cancer-related distress at survival. A cross-sectional descriptive study collecting data (at survival) from retrospective (perceived social support, optimism, distress, coping in the worst situation) and current variables (general stress, distress regarding cancer, benefit finding) was carried out. Forty-one parents of childhood cancer survivors were assessed. High levels of distress (M = 9.5, SD = 1.32, range 4-10) and self-reported efforts to overcome difficulties occurring during the hospitalization (M = 7.48, SD = 3.01, range 0-10) were found. However, parents received high social support from very different sources. This could explain the satisfactory levels of optimism found (43.9% of the sample, M ≥ 16, range 9 - 24). Most parents reported to use engagement (M = 2.57, SD = 0.41, range 1-4) and help-seeking (M = 2.52, SD = 0.53, range 1-4) coping strategies to overcome difficulties. Some parents recognized to use psychological defenses when coping with the distress of cancer. However, this disengagement style was less preferred (M = 1.62, SD = 0.37, range 1-4). Finally, 22% of parents reported positive consequences and 60% reported positive and negative consequences too. When exploring how treatment experiences can influence cancer-related distress in survivorship, we observed that those who received less social support used more disengagement coping and referred higher efforts to overcome difficulties during treatment, displayed persistent distress at survival. These same parents showed higher scores on general stress. Besides, these results were not influenced by child's sequelae at survival. These findings support the hypothesis that "the end of treatment is not the end". Consequently, special attention should be placed in screening parents experiences throughout different milestones of cancer to design tailored interventions aimed at reducing persistent distress at survival.

Caracterización por Ultrasound Tissue Characterization de los tendones rotulianos de jugadores de baloncesto; comparación entre profesionales versus formativos y asintomáticos versus sintomáticos / Patellar tendon analysis by ultrasound tissue characterization; comparison between professional and amateur basketball players. Asymptomatic versus symptomatic

Introducción: La ecografía convencional permite identificar los cambios macroscópicos que se producen en el tendón patológico, sin embargo, estos cambios no se correlacionan bien con los síntomas o la respuesta al tratamiento. La Ultrasound Tissue Characterization (UTC) evalúa la estructura del tendón en 3 dimensiones y la clasifica en 4 eco-tipos. El objetivo de este estudio fue investigar la estructura del tendón rotuliano de jugadores de baloncesto utilizando la técnica de la UTC y estudiar las diferencias entre jugadores profesionales y formativos, comparando la pierna dominante con la pierna no dominante, y sintomáticos con asintomáticos. Material y métodos: Un total de 40 tendones rotulianos (20 jugadores de baloncesto) se incluyeron en el estudio. La estructura del tendón rotuliano (proximal, medial y distal) se cuantificó mediante UTC en el inicio de la pretemporada. La fiabilidad inter e intraobservador se estudió mediante el coeficiente de correlación intraclase (CCI). Resultados: La edad media de los 10 jugadores profesionales y la de los 10 jugadores formativos fue de 28,1 años (DE 4,5) y 17,6 (DE 1,13), respectivamente. El espesor del tendón rotuliano fue mayor en los jugadores profesionales (p < 0,05), en la pierna dominante (p < 0,05) y en los tendones sintomáticos (p < 0,05). No se encontraron diferencias significativas para los eco-tipos, excepto en el caso del eco-tipo II del tendón rotuliano derecho en la porción proximal entre los jugadores profesionales y los académicos (p = 0,05), y en los eco-tipo III y IV del tendón derecho en su porción proximal entre los jugadores sintomáticos y los asintomáticos (p < 0,05). Se encontró una buena-alta fiabilidad con estas técnicas (CCI = 0,80-0,99). Conclusiones: Se ha caracterizado el patrón ecográfico de los tendones rotulianos de jugadores de baloncesto utilizando UTC. El espesor del tendón rotuliano es mayor en los jugadores profesionales que en los jugadores académicos. También se ha observado mayor grosor de los tendones sintomáticos que de los asintomáticos. No hubo diferencias importantes en el patrón de UTC entre los jugadores profesionales y los académicos ni entre los sintomáticos y los asintomáticos (AU)

Introduction: Conventional ultrasound helps to identify the macroscopic changes produced in the injured tendon. However, these changes do not correlate well with the symptoms or the response to treatment. The ‘characterization of tissues by ultrasound’ (UTC) evaluates the structure of the tendon in 3 dimensions and classifies it into 4 echo-types. The aim of this study was to investigate the structure of the patellar tendon in basketball players using the UTC technique, and to study the differences between professional and amateur players by comparing the dominant leg with the non-dominant one, and the asymptomatic with the asymptomatic ones. Material and methods: The study included 40 patellar tendons (20 basketball players). The structure of the patellar tendon (proximal, medial, and distal) was quantified by means of UTC at the beginning of the pre-season. The within and between observer reliability was measured using the intraclass correlation coefficient (ICC). Results: The mean ages of the 10 professional players and 10 amateur players were 28.1 years (SD 4.5) and 17.6 years (SD 1.3), respectively. The thickness of the patellar tendon was greater in the professional players (P < .05), in the dominant leg (P < .05), and in symptomatic tendons (P < .05). There were no significant differences in the echo-types, except in the case of echotype II in the proximal portion of the right patellar tendon, between professional and amateur players (P = .05). Similarly, there was a difference in echo-type III and IV of the proximal portion of the right tendon between symptomatic and asymptomatic players (P < .05). A good, high reliability was found with these techniques (ICC = .80-.99). Conclusions: The ultrasound pattern of the patellar tendons of basketball players has been characterised using UTC. The thickness of the tendon is greater in professional players than in amateur players. It has also been observed that the symptomatic tendons are thicker than in asymptomatic ones. There were no significant differences in the UTC patterns between professional and amateur players, or between symptomatic and asymptomatic ones (AU)

Aromatherapy Improves Work Performance Through Balancing the Autonomic Nervous System.

OBJECTIVE: This study analyzed the efficacy of aromatherapy in improving work performance and reducing workplace stress. SUBJECTS: The initial sample comprised 42 administrative university workers (Mage = 42.21 years, standard deviation = 7.12; 10 male). INTERVENTION: All sessions were performed in a university computer classroom. The participants were randomly assigned into an aromatherapy group (AG) and a control group (CG), and they were invited to participate in a specific session only once. They were seated in front of a computer. During the intervention period, some oil diffusers were switched on and were in operation throughout the session with petitgrain essential oil for AG sessions and a neutral oil (almond) for CG sessions. At the same time, participants completed a computer task on a specific Web site typing on their keyboard until they had finished it. The single times were different for all participants and were recorded on the Web site as "performance time." OUTCOME MEASURES: Before and after the intervention, participants completed anxiety and mood state questionnaires (the Stait-Trait Anxiety Inventory [STAI] and the Profile of Mood States [POMS]). Heart-rate variability (HRV) was measured before (PRE), during (20-25 min), and after (POS) the intervention to analyze autonomic nervous system regulation. RESULTS: The AG performed the Web site task 2.28 min faster than the CG (p = 0.05). The two groups showed differences in the following HRV parameters: low frequency (p = 0.05), high frequency (p = 0.02), standard deviation of all RR intervals (p = 0.05), and root mean square of differences (p = 0.02). All participants in all groups showed a decrease from PRE to POST for STAI (p < 0.001), Tension-POMS (p < 0.001), and Vigour-POMS (p = 0.01) scales. CONCLUSIONS: Aromatherapy (inhaling petitgrain essential oil) can improve performance in the workplace. These results could be explained by an autonomic balance on the sympathetic/parasympathetic system through a combined action of the petitgrain main components (linalyl acetate, linalool, and myrcene). The final effect could be an improvement of the mental and emotional condition by a combination of reducing the stress level and increasing the arousal level of the participants in terms of attentiveness and alertness.

The hidden sufferers: parental reactions to childhood cancer during treatment and at survival

This study was twofold: 1) to assess parental reactions to childhood cancer throughout the oncological experience and 2) to explore associations between parents’ reactions during treatment and cancer-related distress at survival. A cross-sectional descriptive study collecting data (at survival) from retrospective (perceived social support, optimism, distress, coping in the worst situation) and current variables (general stress, distress regarding cancer, benefit finding) was carried out. Forty-one parents of childhood cancer survivors were assessed. High levels of distress (M = 9.5, SD = 1.32, range 4-10) and self-reported efforts to overcome difficulties occurring during the hospitalization (M = 7.48, SD = 3.01, range 0-10) were found. However, parents received high social support from very different sources. This could explain the satisfactory levels of optimism found (43.9% of the sample, M ≥ 16, range 9 - 24). Most parents reported to use engagement (M = 2.57, SD = 0.41, range 1-4) and help-seeking (M = 2.52, SD = 0.53, range 1-4) coping strategies to overcome difficulties. Some parents recognized to use psychological defenses when coping with the distress of cancer. However, this disengagement style was less preferred (M = 1.62, SD = 0.37, range 1-4). Finally, 22% of parents reported positive consequences and 60% reported positive and negative consequences too. When exploring how treatment experiences can influence cancer-related distress in survivorship, we observed that those who received less social support used more disengagement coping and referred higher efforts to overcome difficulties during treatment, displayed persistent distress at survival. These same parents showed higher scores on general stress. Besides, these results were not influenced by child’s sequelae at survival. These findings support the hypothesis that 'the end of treatment is not the end'. Consequently, special attention should be placed in screening parents experiences throughout different milestones of cancer to design tailored interventions aimed at reducing persistent distress at survival (AU)

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