Contraindicaciones para la práctica deportiva. Documento de Consenso de la Sociedad Española de Medicina del Deporte (SEMED). Versión 2023 / Contraindications of sports practice. Consensus document of the Spanish Society of Sports Medicine (SEMED). Version 2023

La función principal de la medicina del deporte es el cuidado de la salud del deportista, no solo desde el punto de vista del tratamiento, sino también desde el de la prevención. Los reconocimientos médicos para la aptitud deportiva, una de las atribuciones principales de esta especialidad, están destinados a descubrir patologías, enfermedades o alteraciones que pueden afectar a la salud, y abarcan desde las situaciones que pueden desencadenar incidentes mortales hasta las que, sin poner en riesgo la vida, pueden afectar la salud o el rendimiento del deportista. La realización adecuada de reconocimientos para el deporte implica el diagnóstico de problemas médicos que deben analizarse, entre otros puntos de vista, desde la óptica de la aptitud para la práctica deportiva, y el médico encargado debe disponer de una guía que le oriente sobre la decisión de autorizar o no la práctica de deporte, y en caso de no autorización, la temporalidad de esta y el riesgo asumible de participación en algunos deportes. Las contraindicaciones para la práctica deportiva mejor conocidas son las de origen cardiovascular, tratadas extensamente en la literatura, pero también existen contraindicaciones del resto de aparatos y sistemas del organismo, entendiendo que el deportista es un ser completo y que el ejercicio físico afecta a todo su conjunto. Este documento, además de recoger dichas contraindicaciones, analiza los aspectos legales que afectan a los profesionales en los que recae la responsabilidad de realizar los reconocimientos y los aspectos documentales que les son propios.(AU)

Main purpose of sports medicine is reaching the health care of the athlete, not only from the point of view of treatment, but also from the point of view of prevention. The performance of preparticipation medical sports evaluation, one of the main attributions of this specialty, is aimed at the discovery of pathologies, diseases or alterations that may affect health. They might range from situations that can trigger deadly incidents, to those without putting life at risk, can affect the health or performance of the athlete. Adequate implementation of preparticipation medical sports evaluation implies the diagnosis of medical problems that must be analyzed, from other points of view such as the perspective of fitness for sport practice. In addition, the doctor in charge must have a guide for clearance for sports practice. In case of non-authorization, time for non-sports activities must be recommended in order to decrease injury risks. Cardiovascular pathologies are the best-known contraindications in sport practice, treated extensively in the literature. However, there are also contraindications secondary to problems or issues of the rest of apparatus organs and systems of the organism, knowing that the athlete represents an entity in which physical exercise affects all their sets. This document highlights those contraindications already discussed above and analyzes the legal aspects of sports practice contraindications. Medical professionals are responsible for managing the pre-participation medical sports evaluation as well as the documentary aspects that support it.(AU)

Forty-five years of research on vegetarianism and veganism: A systematic and comprehensive literature review of quantitative studies.

Meat production and consumption are sources of animal cruelty, responsible for several environmental problems and human health diseases, and contribute to social inequality. Vegetarianism and veganism (VEG) are two alternatives that align with calls for a transition to more ethical, sustainable, and healthier lifestyles. Following the PRISMA guidelines, we conducted a systematic literature review of 307 quantitative studies on VEG (from 1978 to 2023), collected from the Web of Science in the categories of psychology, behavioral science, social science, and consumer behavior. For a holistic view of the literature and to capture its multiple angles, we articulated our objectives by responding to the variables of "WHEN," "WHERE," "WHO," "WHAT," "WHY," "WHICH," and "HOW" (6W1H) regarding the VEG research. Our review highlighted that quantitative research on VEG has experienced exponential growth with an unbalanced geographical focus, accompanied by an increasing richness but also great complexity in the understating of the VEG phenomenon. The systematic literature review found different approaches from which the authors studied VEG while identifying methodological limitations. Additionally, our research provided a systematic view of factors studied on VEG and the variables associated with VEG-related behavior change. Accordingly, this study contributes to the literature in the field of VEG by mapping the most recent trends and gaps in research, clarifying existing findings, and suggesting directions for future research.

Intratumoral injection of the seasonal flu shot converts immunologically cold tumors to hot and serves as an immunotherapy for cancer.

Reprogramming the tumor microenvironment to increase immune-mediated responses is currently of intense interest. Patients with immune-infiltrated "hot" tumors demonstrate higher treatment response rates and improved survival. However, only the minority of tumors are hot, and a limited proportion of patients benefit from immunotherapies. Innovative approaches that make tumors hot can have immediate impact particularly if they repurpose drugs with additional cancer-unrelated benefits. The seasonal influenza vaccine is recommended for all persons over 6 mo without prohibitive contraindications, including most cancer patients. Here, we report that unadjuvanted seasonal influenza vaccination via intratumoral, but not intramuscular, injection converts "cold" tumors to hot, generates systemic CD8+ T cell-mediated antitumor immunity, and sensitizes resistant tumors to checkpoint blockade. Importantly, intratumoral vaccination also provides protection against subsequent active influenza virus lung infection. Surprisingly, a squalene-based adjuvanted vaccine maintains intratumoral regulatory B cells and fails to improve antitumor responses, even while protecting against active influenza virus lung infection. Adjuvant removal, B cell depletion, or IL-10 blockade recovers its antitumor effectiveness. Our findings propose that antipathogen vaccines may be utilized for both infection prevention and repurposing as a cancer immunotherapy.

Efecto de la cafeína como ayuda ergogénica para evitar y prevenir la fatiga muscular / Effect of caffeine as an ergogenic aid to prevent muscle fatigue

La cafeína, una de las sustancias psicoactivas de mayor consumo a nivel mundial, se ha relacionado con el retraso en la aparición de la fatiga muscular y la disminución en la percepción del esfuerzo durante la actividad física. Debido al aumento progresivo en el consumo de complementos alimenticios para mejorar el rendimiento deportivo, decidimos realizar esta revisión con el objetivo de sintetizar la evidencia disponible sobre el efecto de la cafeína como ayuda ergogénica en la fatiga central y periférica, examinando los mecanismos de acción y especificando las dosis y la forma de administración idóneas para obtener el efecto ergogénico deseado. Para ello se realizó una búsqueda bibliográfica entre enero de 2008 y mayo de 2018, identificando estudios publicados en bases de datos electrónicas (PubMed, SciELO, Dialnet) y documentos de organismos nacionales e internacionales (EFSA, AECOSAN, SEMED/FEMEDE, AIS, EUFIC, WADA) sobre la cafeína y su efecto sobre la fatiga muscular. Se analiza el mecanismo de acción de la cafeína en deportes de fuerza y resistencia, así como las dosis, vías y pautas de administración óptimas. Se revisan además otros aspectos como la toxicidad, el dopaje y la normativa actual que regula el etiquetado de los complementos alimenticios que contienen cafeína

Caffeine, one of the most widely used psychoactive substances worldwide, has been linked to the delay in the appearance of neuromuscular fatigue and the reduction in the effort perception during physical activity. As a result of a progressive increase in the consumption of food supplements to improve the sports performance, we decided to review the ergogenic effect of caffeine on muscle fatigue at central and peripheral levels. A bibliographic search was conducted between january 2008 and may 2018, identifying studies published in electronic databases (PubMed, SciELO, Dialnet) and documents from national and international organizations (EFSA, AECOSAN, SEMED/FEMEDE, AIS, EUFIC, WADA) about caffeine and its effect on muscle fati-gue. The mechanism of action of caffeine in strength and endurance sports is analyzed, as well as the optimal dosage, routes of administration and posology guidelines. We also review other aspects such as toxicity, doping and the current legislation that regulates the labeling of food supplements containing caffeine

Nuevos entornos de aprendizaje para la escritura: Sistemas de tutoría inteligente / New learning environments for writing: Intelligent tutoring systems

Numerosos metaanálisis han demostrado cómo el uso de la tecnología es una práctica efectiva en el campo de la instrucción en escri-tura. Sin embargo, la mayor parte de estos estudios se han centrado en los efectos del procesador de Word para mejorar la escritura de los estudiantes. Este trabajo investiga y muestra los efectos de nuevas formas de instrucción en la escritura, como son los Sistemas de Tutoría Inteligente (STI), una de las herramientas más sofisticadas dentro del campo de los entornos virtuales de aprendizaje. Se ha revisado sistemáticamente la literatura de la última década procedente de Web of Science, ScienceDirect y Scopus. El potencial de los Sistemas de Tutoría Inteligente está claramente respaldado por los hallazgos actuales. Sin embargo, hay resultados contradictorios con respecto al rendimiento de los estudiantes. Esta revisión plantea una discusión sobre los resultados de cara a comprender mejor la relación entre tecnología e instrucción en escritura

Abundant meta-analyses have shown how the use of technology is an effective practice in the field of writing instruction. However, most of these studies have focused on the effects of the word processor to improve student writing. This article investigates and shows the effects of new forms of instruction in writing, such as intelligent tutoring systems (ITS), one of the most sophisticated tools in the field of virtual learning environments. The literature of the last decade from the Web of Science, ScienceDirect and Scopus has been systematically reviewed. The potential of intelligent tutoring systems is clearly supported by the current findings. However, there are contradictory results concerning students' performance. This review presents a discussion on the results in order to understand in more detail the relationship between technology and instruction in writing

Inaccessible rocky cliffs: An optimized method for plant data collection in extreme environments.

Counts are normally used to assess the densities of plants. However, due to the physical characteristics of these sites, habitats and species associated with inaccessible rocky cliffs and other extreme environments pose additional challenges. It is therefore necessary to apply changes to the usual data collection methods. This system allows population sizes to be estimated from an incomplete data collection. This is important because when data collection sites are inaccessible, the fieldwork cannot be carried out within the time that is normally allocated. Furthermore, the minimum sampling effort involved enables economic resources to be saved. This method allows the time spent and the material, methodological and human resources used to be reduced while simultaneously allowing the highest level of accuracy to be maintained. •The minimum effort needed to carry out data collection of plants on vertical walls and other difficult-to-access environments is calculated.•The proposed method is based on the search for the theoretical distribution function with a better adjustment to the actual distribution of the studied species.•This system allows to reduce the necessary resources, while the maximum accuracy is maintained in the calculations.

What makes implementation intention interventions effective for promoting healthy eating behaviours? A meta-regression.

This study examines the efficacy of implementation intentions (II), a widely used self-regulatory strategy to help people achieve their goals. Although previous research has shown that the effect of II interventions is significantly higher in promoting healthy eating behaviours than in diminishing unhealthy eating behaviours, the factors that can moderate the effectiveness of these interventions remain unclear. In a meta-analysis of 70 interventions (N = 9689), we confirmed that II interventions for healthy eating behaviours yielded a medium significant effect size (d = 0.33) and a low significant effect size for unhealthy eating behaviors (d = 0.18). We show that the moderator variables of II interventions for healthy and unhealthy eating goals are very different. Regarding healthy eating, since moderator variables explain 53% of the variance in the heterogeneity of the effect sizes, the present study helps in gaining an understanding of the previous inconsistent results and offers suggestions for designing more efficient interventions. Effect size was negatively predicted by age, indicating that for younger people the effect size is higher, and II check, showing that if the instructor checks the plan it decreases its efficacy. Moreover, the effect of II interventions on students is significantly smaller than in non-student samples. In contrast, the effect size was positively predicted by initial training, off-line delivered interventions and, specific if-then and action plans versus complex plans. For unhealthy eating behaviours, our results show that there is less room to improve the intervention; there is only one moderator variable (plan formulation), and the heterogeneity found in the studies is lower for unhealthy eating behaviours (I2 = 46.70%) than for healthy eating behaviours (I2 = 73.25%), indicating that the intervention has low efficacy regardless of the design of the intervention.

Suplementos nutricionales para el deportista. Ayudas ergogénicas en el deporte - 2019. Documento de consenso de la Sociedad Española de Medicina del Deporte / Nutritional supplements for athletes. Ergogenic aids in sport - 2019. Consensus document of the Spanish Society of Sports Medicine

En el año 2012 se publicó el consenso "Ayudas ergogénicas nutricionales para las personas que realizan ejercicio físico" que ha servido durante estos años como referente en la materia para muchos profesionales de la materia. La modificación de normativas y la aparición de nuevas evidencias han aconsejado efectuar un nuevo documento, en esta ocasión "Suplementos nutricionales para el deportista. Ayudas ergogénicas en el deporte" que supone una puesta al día rigurosa sobre la evidencia existente, sobre la legislación actual en el contexto europeo y sobre las expectativas de futuro. El documento describe en profundidad los suplementos que se utilizan en la actualidad agrupándolos en hidratos de carbono, bebidas especialmente diseñadas para el deportista, Proteínas como ayuda ergogénica en el deporte, minerales, vitaminas, ácidos grasos y otros componentes (creatina, β-hidroxi-β-metil-butirato, carnitina, mezclas de aminoácidos ramificados, otros aminoácidos y sustancias nitrogenadas, cafeína, guaraná y té verde, antioxidantes, inmunomoduladores, bicarbonatos y citratos, ginseng, glicerol, cannabidiol, melatonina, leptina, sulfato de condroitina, sulfato de glucosamina, ácido hialurónico, bromelina, nitratos y otras ayudas ergogénicas.Se presentan las evidencias de consenso actuales y un novedoso diagrama de decisión en relación con la utilización de suplementos nutricionales en el deporte para terminar efectuando importantes recomendaciones para el deportista que se entrena y compite y se incorporan las recomendaciones sobre el uso de suplementos nutricionales y de ayudas ergogénicas para prevenir el dopaje accidental. Este documento constituye una verdadera puesta al día en los suplementos nutricionales que se utilizan actualmente y sirve como rigurosa guía de utilización para los profesionales que trabajan en el deporte y en la actividad física

In 2012 the consensus "Nutritional ergogenic aids for physical exercise practitioners" was published, which has served during these years as a reference in the field for many professionals of the field. The modification of regulations and the appearance of new evidence have made it advisable to produce a new document, this time "Nutritional supplements for athletes. Ergogenic aids in sport" which means a rigorous update on the existing evidence, on the current legislation in the European context and on the expectations for the future. The document deeply describes the supplements that are currently used by grouping them into carbohydrates, drinks specially designed for athletes, proteins as an ergogenic aid in sport, minerals, vitamins, fatty acids and other components (creatine, β-hydroxy-β-methyl-butyrate, carnitine), mixtures of branched amino acids, other amino acids and nitrogenous substances, caffeine, guarana and green tea, antioxidants, immunomodulators, bicarbonates and citrates, ginseng, glycerol, cannabidiol, melatonin, leptin, chondroitin sulphate, glucosamine sulphate, hyaluronic acid, bromelain, nitrates and other ergogenic aids. It is presented the evidence of current consensus and a novel decision diagram regarding the use of nutritional supplements in sport to end up making important recommendations for the athlete who trains and competes and incorporates recommendations on the use of nutritional supplements and ergogenic aids to prevent accidental doping. This document is an update on the nutritional supplements currently in use and serves as a rigorous user guide for professionals working in sport and physical activity

Estudio del estado de hidratación de futbolistas profesionales mediante diferentes métodos de evaluación de la composición corporal / Evaluation of the hydration status in professional football players through different body composition assessment techniques

Introducción: El estado de hidratación del individuo durante la práctica deportiva, es uno de los temas más importantes en la actualidad en relación a la práctica de ejercicio físico, sobre todo, en ambientes calurosos y de duración prolongada (>1h). En el presente estudio, se analiza el estado de hidratación de jugadores profesionales de fútbol, integrantes del Real Valladolid B, durante una sesión de entrenamiento en diferentes épocas del año, con el fin de, además de comprobar su estado de hidratación, poder observar de qué manera influye el clima en dicho estado. Dado que una alteración en el estado de hidratación, será perjudicial para el deportista, afectando tanto a su rendimiento físico, como a su salud, el cumplimiento de una serie de normas y pautas existentes será imprescindible para mantener un estado óptimo de hidratación. Métodos: Se usaron distintos métodos de evaluación de la hidratación. Un registro de doble pesada, una bioimpedanciometría pre y post entrenamiento, una cineantropometría pre y post entrenamiento y la medición de la densidad de orina únicamente post entrenamiento. Resultados: Los resultados mostraron diferencias significativas en cuanto a la diferencia de peso entre el pre y post entrenamiento, y en el% de variación de peso entre enero y mayo. La densidad de orina indicó también la aparición de un estado de deshidratación postejercicio. La bioimpedancia y la antropometría mostraron diferencias significativas y una concordancia baja entre ellas, siendo la antropometría la más sensible. Conclusiones: La diversidad de resultados obtenidos, relacionados con la aparición de un estado de deshidratación en los jugadores en el momento postejercicio, sugiere la necesidad de aconsejar y concienciar a los deportistas sobre el cumplimiento de estrategias de reposición hidroelectrolítica individualizadas, teniendo en cuenta las características propias del individuo, así como las externas a este

Introduction: The hydration status of the individual during sports is currently one of the most important issues in relation to the practice of physical exercise, especially in hot and long-lasting environments (>1h). In the present study, the hydration status of professional football players, members of Real Valladolid B, is analysed during a training session at different times of the year in order to check their hydration status, as well as to observe in which way the climate influences the aforesaid state. Since a variation in the hydration status, whether dehydration or overhydration, is harmful for the athlete, affecting both his physical performance and health. Thus, in order to maintain an ideal hydration status throughout the physical effort, it will be essential to accomplish a set of regulations and guidelines. Methods: For this purpose, different hydration assessment techniques are used. These techniques comprise a double weight recording, a bioimpedance analysis before and after training, a cineantropometry before and after training, and, only after training, the measurement of the density of the urine. Results: the results showed differences regarding the different weight obtained before and after training, as well as a variation in the weight percentage between january and may. Urine density also pointed out the manifestation of a state of post-exercise dehydration. Furthermore, the bioimpedance and anthropometry reflected significant differences and low consistency between them, being anthropometry the most accurate method. Conclusions: the diversity of results obtained, related to the appearance of a state of dehydration in players at the postexercise moment, suggests the necessity of advising and raising awareness among the athletes about the compliance of the individualized strategies of hydroelectricity replacement, taking into account the personal characteristics of the individual, as well as those that are external to him

Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages.

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

Lesiones deportivas versus accidentes deportivos. Documento de consenso. Grupo de prevención en el deporte de la Sociedad Española de Medicina del Deporte (SEMED-FEMEDE) / Sports injuries versus sports accidents. Consensus document. Group of prevention in the sport of the Spanish Society of Sports Medicine (SEMED-FEMEDE)

La práctica deportiva tiene numerosos efectos beneficiosos sobre la salud y el bienestar de las personas, pero también puede tener efectos negativos, entre los que se encuentran los accidentes y las lesiones. Establecer las diferencias entre lesión y accidente deportivo es de vital importancia desde el punto de vista médico-legal y ayudará a clarificar la regulación jurídica del deporte en estos aspectos. Por ello, el objetivo de este documento es establecer un consenso sobre lo que entendemos por lesión deportiva y sobre qué tipos de lesiones pueden calificarse como accidente deportivo. Se vienen utilizando diferentes criterios, muy dispares, para definir las lesiones deportivas, así como para clasificarlas, lo que lleva a que los datos epidemiológicos no puedan extrapolarse de unos a otros. Así, para unos son todas aquellas que requieren asistencia médica; otros consideran que existe una lesión cuando hay daño corporal que obliga al deportista a abandonar o modificar una o más sesiones de entrenamiento o competición; otros autores entienden que una lesión deportiva debe combinar la necesidad de asistencia médica con la pérdida de tiempo de las actividades deportivas; y finalmente algunos estiman que una lesión deportiva es cualquier problema físico sufrido por un deportista durante el entrenamiento o la competición, independientemente de la necesidad de atención médica y de la pérdida de tiempo de actividades deportivas. Bajo el punto de vista de este consenso, una lesión deportiva es un problema físico debido a una alteración de la integridad de los tejidos que se produce como resultado de la práctica de actividad física o deporte, y que altera la capacidad absoluta o relativa de practicar deporte, independientemente de que requiera atención de personal sanitario o que conlleve ausencias o modificaciones en las sesiones de entrenamiento o en las competiciones. Puede aparecer de forma súbita, en el caso de las lesiones agudas, o tener un comienzo lento y progresivo, en el caso de lesiones por sobrecarga o sobreuso. Un accidente deportivo es una lesión corporal, no intencionada por parte del accidentado, de inicio repentino, provocada por un traumatismo o una carga que supere los límites fisiológicos, y que acontece durante una actividad deportiva identificable. Las causas de los accidentes varían en función de la modalidad deportiva, del terreno donde se practica el deporte, del material deportivo, etc. Todas las lesiones agudas (por traumatismos, malos gestos técnicos o cargas que superen los límites fisiológicos y provoquen un daño tisular) deben ser consideradas como accidentes deportivos, y aquellas en las que el daño tisular aparece en un determinado momento y es progresivo, pudiendo manifestarse clínicamente o no (sobrecargas de repetición), quedan excluidas de lo que entendemos por accidente deportivo

Sports practice has many beneficial effects on the health and well-being of people, but it can also have negative effects between those tha are accidents and injuries. Establishing the differences between injury and sports accident is of vital importance from the medical-legal point of view and will help to clarify the legal regulation of sport in these aspects. Therefore, the purpose of this document is to establish a consensus on what we understand as sports injury and what kind of injuries can be classified as sports accidents. Different criteria have been used, very differente, to define sports injuries, and to classify them, so that epidemiological data cannot be extrapolated from some study to other. Thus, for some are all those that require medical assistance; Others consider that there is an injury when there is bodily injury that forces the athlete to leave or modify one or more training session or competition; another group of authors understand that a sports injury must combine the need for medical assistance with the loss of time from sports activities; finally, others estimate that a sports injury is any physical problem suffered by an athlete during training or competition, regardless of the need for medical attention and loss of time from sports activities. From our point of view, a sports injury is a physical problem due to an alteration of the integrity of the tissues that occurs as a result of the practice of physical activity or sport, and that alters the absolute or relative capacity to practice sport, independently of the fact that it requires attention of sanitary personnel or that it involves absences or modifications in training sessions or competitions. It can appear suddenly, in the case of acute injuries or have a slow and progressive onset, in the case of overload or overuse injuries. A sports accident is a bodily injury, unintentional by the injured person, of sudden onset, caused by trauma or a load that exceeds physiological limits and that occurs during an identifiable sports activity. The causes of accidents depend on the sport modality, sports playground, sports equipment, etc. All acute injuries (due to trauma, incorrect sport technique or loads that exceed physiological limits and cause tissue damage) should be considered as sports accidents and those in which the tissue damage appears at a certain time and is progressive, being able to manifest itself clinically or not (repeated overloads), are excluded from what we understand by sports accidents

Contraindicaciones para la práctica deportiva. Documento de consenso de la Sociedad Española de Medicina del Deporte (SEMED-FEMEDE) / Contraindications of sports practice. Consensus document of the SPANISH Society of Sports Medicine (SEMED-FEMEDE)

La función principal de la medicina del deporte es el cuidado de la salud del deportista, no solo desde el punto de vista del tratamiento, sino también desde el de la prevención. Los reconocimientos médicos para la aptitud deportiva, una de las atribuciones principales de esta especialidad, están destinados a descubrir patologías, enfermedades o alteraciones que pueden afectar a la salud, y abarcan desde las situaciones que pueden desencadenar incidentes mortales hasta las que, sin poner en riesgo la vida, pueden afectar la salud o el rendimiento del deportista. La realización adecuada de reconocimientos para el deporte implica el diagnóstico de problemas médicos que deben analizarse, entre otros puntos de vista, desde la óptica de la aptitud para la práctica deportiva, y el médico encargado debe disponer de una guía que le oriente sobre la decisión de autorizar o no la práctica de deporte, y en caso de no autorización, la temporalidad de esta y el riesgo asumible de participación en algunos deportes. Las contraindicaciones para la práctica deportiva mejor conocidas son las de origen cardiovascular, tratadas extensamente en la literatura, pero también existen contraindicaciones del resto de aparatos y sistemas del organismo, entendiendo que el deportista es un ser completo y que el ejercicio físico afecta a todo su conjunto. Este documento, además de recoger dichas contraindicaciones, analiza los aspectos legales que afectan a los profesionales en los que recae la responsabilidad de realizar los reconocimientos y los aspectos documentales que les son propios

Main purpose of sports medicine is reaching the health care of the athlete, not only from the point of view of treatment, but also from the point of view of prevention. The performance of preparticipation medical sports evaluation, one of the main attributions of this specialty, is aimed at the discovery of pathologies, diseases or alterations that may affect health. They might range from situations that can trigger deadly incidents, to those without putting life at risk, can affect the health or performance of the athlete. Adequate implementation of preparticipation medical sports evaluation implies the diagnosis of medical problems that must be analyzed, from other points of view such as the perspective of fitness for sport practice. In addition, the doctor in charge must have a guide for clearance for sports practice. In case of non-authorization, time for non-sports activities must be recommended in order to decrease injury risks. Cardiovascular pathologies are the best known contraindications in sport practice, treated extensively in the literature. However, there are also contraindications secondary to problems or issues of the rest of apparatus organs and systems of the organism, knowing that the athlete represents an entity in which physical exercise affects all their sets. This document highlights those contraindications already discussed above and analyzes the legal aspects of sports practice contraindications. Medical professionals are responsible for managing the pre-participation medical sports evaluation as well as the documentary aspects that support it

Dopaje genético. ¿Estamos dispuestos a arriesgar? / Gene doping. Are we willing to risk it?

No disponible

Reducing fat intake using implementation intentions: A meta-analytic review.

PURPOSE: To study the efficacy of forming implementation intentions for fat intake reduction as well as possible moderating variables. METHODS: Systematic review and meta-analysis of 12 empirical studies (N = 3,323) published in English and Spanish in the Web of Science (Core Collection) and MEDLINE (1990-January 2016) databases. RESULTS: This study found that the efficacy of planning interventions on fat consumption reduction was higher than expected, as a moderate overall effect of implementation intentions was observed (d = 0.488). Moreover, planning for a fat intake reduction seems to be more powerful for men than for women (ß = -.623; p = .025) and in cases where there is no monitoring during the intervention (d = 0.671 vs. d = 0.231). CONCLUSIONS: Previous research was sceptical of the efficacy of planning in the case of avoiding goals in healthy eating. However, our results show that planning is an efficient intervention that can be used by health education programmes to reduce fat intake and, therefore, increase citizen well-being. These results also support the existence of a key variable in the implementation intentions process, that is, goal complexity, and the presence of two moderating variables, that is, gender and monitoring. Statement of contribution What is already known on this subject? Implementation intentions are action plans subordinate to goal intentions that specify the 'when, where, and how' of responses leading to goal attainment. In healthy eating, the average effect of forming implementation intentions is small to medium, but this efficacy changes depending on the type of intended behaviour. Past evidence shows that the effect size seems to be lower when the intervention aims at reducing unhealthy behaviours versus promoting healthy behaviours. What does this study add? Forming implementation intentions is an efficient intervention to reduce fat intake with a medium overall effect. The efficacy of this intervention is increased when men are targeted and when there is no monitoring during the process. This study introduces a new line of research focused on the study of the effect of planning on complex goals.

Synchronous primary malignancies of the appendix and ovary causing carcinomatosis in one patient.

Associated tumors of the ovary and the appendix are commonly found in cases of pseudomyxoma peritonei (PP); the origin of these tumors are a continually debated topic. Outside of the setting of PP, this finding is exceedingly rare and there are no documented reports of two primary processes causing carcinomatosis in the absence of PP. Here, we present a patient who underwent cytoreductive surgery for peritoneal carcinomatosis presumptively secondary to ovarian carcinoma and who on pathological examination was found to have synchronous primary malignant processes of both the appendix and the ovary. This represents the first documented case of carcinomatosis resulting from two separate malignant processes in the absence of PP.

Resting energy expenditure; assessment methods and applications

The energetic expense daily total of an individual (EEDT) represents the energy that the organism consumes. It is constituted by the sum of: metabolic basal rate (MBR), termogenesis endogenous (TE) and energetic expense linked to the physical activity (EEPA). The determination of the EEDT considering the physical activity and the state of health of a person, it is very important to fit the calculation of the nutritional need for every individual. The MBR is the minimal quantity of energy that an organism needs to be alive. It constitutes a from 60 to 70 % of the EEPA in the majority of the sedentary adults, while, in the physically very active individuals it is of approximately 50 %. It changes depending on the corporal composition, specially on the corporal lean mass. The basal metabolism expressed as MRB, it is different from the metabolic rate in rest (MRR) or Resting energy expenditure (REE); the latter is obtained when the determination is done in rest and in the conditions described for the MRB but not in fasting, including therefore the energy used for the biological utilization of the food. Habitually, the REE decides by means of different technologies as the indirect calorimetry, the electrical bioimpedancy, the doubly marked water, the predictive equations, between others. These methods are used in the clinical practice and in scientific studies. Nevertheless, due to the inconsistency of the results of these researches, still there is no a consensus with regard to his applicability though the evidence indicates that the measurement of the consumption of oxygen, it is the method of major precision. Aims: This review has as aim expose the components of the energetic expense in rest, as well as the technologies for its determination and estimation, indicating its advantages, limitations and practical applications. Results: Part of the technologies of evaluation of the energetic expense described in this review, they remain relegated, for its complexity and cost to the area of the investigation. For a long time the indirect calorimetry, she remained also restricted to this field. Nevertheless, the technological advances have allowed the development of precise light and attainable equipments that allow that at present it should be a very useful method in the clinical space of the determination of the REE (AU)

El gasto energético total diario de un individuo (GETD) representa la energía que el organismo consume. Está constituido por la suma de: tasa metabólica basal (TMB), termogénesis endógena (TE) y gasto energético ligado a la actividad física (GEAF). La determinación del GETD considerando la actividad física y el estado de salud de una persona, es muy importante para ajustar el cálculo de la necesidad nutricional para cada individuo. La TMB es la mínima cantidad de energía que un organismo requiere para estar vivo. Constituye del 60 al 70% del GETD en la mayoría de los adultos sedentarios, en tanto, en los individuos físicamente muy activos es de aproximadamente el 50%. Varía dependiendo de la composición corporal, especialmente de la masa corporal magra. El metabolismo basal expresado como TMB, es diferente a la tasa metabólica en reposo (TMR) o Gasto Energético en Reposo (GER); este último se obtiene cuando la determinación se hace en reposo y en las condiciones descritas para la TMB pero no en ayuno, incluyendo por tanto la energía utilizada para el aprovechamiento biológico de los alimentos. Habitualmente, el GER se determina por medio de diferentes técnicas como la calorimetría indirecta, la bioimpedancia eléctrica, el agua doblemente marcada, las ecuaciones predictivas, entre otras. Estos métodos son utilizados en la práctica clínica y en estudios científicos. Sin embargo, debido a la inconsistencia de los resultados de estas investigaciones, todavía no hay un consenso respecto a su aplicabilidad aunque la evidencia señala que la medición del consumo de oxígeno, es el método de mayor precisión. Objetivos: Esta revisión tiene como objetivo exponer los componentes del gasto energético en reposo, así como las técnicas para su determinación y estimación, señalando sus ventajas, limitaciones y aplicaciones prácticas. Resultados: Parte de las técnicas de evaluación del gasto energético descritas en esta revisión, quedan relegadas, por su complejidad y coste al ámbito de la investigación. Durante mucho tiempo la calorimetría indirecta, quedó también restringida a este campo. Sin embargo, los avances tecnológicos han permitido el desarrollo de equipos precisos ligeros y asequibles que permiten que en la actualidad sea un método muy útil en el espacio clínico de la determinación del GER (AU)

Resting energy expenditure; assessment methods and applications.

UNLABELLED: The energetic expense daily total of an individual (EEDT) represents the energy that the organism consumes. It is constituted by the sum of: metabolic basal rate (MBR), termogenesis endogenous (TE) and energetic expense linked to the physical activity (EEPA). The determination of the EEDT considering the physical activity and the state of health of a person, it is very important to fit the calculation of the nutritional need for every individual. The MBR is the minimal quantity of energy that an organism needs to be alive. It constitutes a from 60 to 70 % of the EEPA in the majority of the sedentary adults, while, in the physically very active individuals it is of approximately 50 %. It changes depending on the corporal composition, specially on the corporal lean mass. The basal metabolism expressed as MRB, it is different from the metabolic rate in rest (MRR) or Resting energy expenditure (REE); the latter is obtained when the determination is done in rest and in the conditions described for the MRB but not in fasting, including therefore the energy used for the biological utilization of the food. Habitually, the REE decides by means of different technologies as the indirect calorimetry, the electrical bioimpedancy, the doubly marked water, the predictive equations, between others. These methods are used in the clinical practice and in scientific studies. Nevertheless, due to the inconsistency of the results of these researches, still there is no a consensus with regard to his applicability though the evidence indicates that the measurement of the consumption of oxygen, it is the method of major precision. AIMS: This review has as aim expose the components of the energetic expense in rest, as well as the technologies for its determination and estimation, indicating its advantages, limitations and practical applications. RESULTS: Part of the technologies of evaluation of the energetic expense described in this review, they remain relegated, for its complexity and cost to the area of the investigation. For a long time the indirect calorimetry, she remained also restricted to this field. Nevertheless, the technological advances have allowed the development of precise light and attainable equipments that allow that at present it should be a very useful method in the clinical space of the determination of the REE.

El gasto energético total diario de un individuo (GETD) representa la energía que el organismo consume. Está constituido por la suma de: tasa metabólica basal (TMB), termogénesis endógena (TE) y gasto energético ligado a la actividad física (GEAF). La determinación del GETD considerando la actividad física y el estado de salud de una persona, es muy importante para ajustar el cálculo de la necesidad nutricional para cada individuo. La TMB es la mínima cantidad de energía que un organismo requiere para estar vivo. Constituye del 60 al 70% del GETD en la mayoría de los adultos sedentarios, en tanto, en los individuos físicamente muy activos es de aproximadamente el 50%. Varía dependiendo de la composición corporal, especialmente de la masa corporal magra. El metabolismo basal expresado como TMB, es diferente a la tasa metabólica en reposo (TMR) o Gasto Energético en Reposo (GER); este último se obtiene cuando la determinación se hace en reposo y en las condiciones descritas para la TMB pero no en ayuno, incluyendo por tanto la energía utilizada para el aprovechamiento biológico de los alimentos. Habitualmente, el GER se determina por medio de diferentes técnicas como la calorimetría indirecta, la bioimpedancia eléctrica, el agua doblemente marcada, las ecuaciones predictivas, entre otras. Estos métodos son utilizados en la práctica clínica y en estudios científicos. Sin embargo, debido a la inconsistencia de los resultados de estas investigaciones, todavía no hay un consenso respecto a su aplicabilidad aunque la evidencia señala que la medición del consumo de oxígeno, es el método de mayor precisión. Objetivos: Esta revisión tiene como objetivo exponer los componentes del gasto energético en reposo, así como las técnicas para su determinación y estimación, señalando sus ventajas, limitaciones y aplicaciones prácticas. Resultados: Parte de las técnicas de evaluación del gasto energético descritas en esta revisión, quedan relegadas, por su complejidad y coste al ámbito de la investigación. Durante mucho tiempo la calorimetría indirecta, quedó también restringida a este campo. Sin embargo, los avances tecnológicos han permitido el desarrollo de equipos precisos ligeros y asequibles que permiten que en la actualidad sea un método muy útil en el espacio clínico de la determinación del GER.

Gasto energético en reposo. Métodos de evaluación y aplicaciones / Resting energy expenditure: assessment methods and applications

El gasto energético total diario de un individuo (GETD) representa la energía que el organismo consume. Está constituido por la suma de: tasa metabólica basal (TMB), termogénesis endógena (TE) y gasto energético ligado a la actividad física (GEAF). La determinación del GETD considerando la actividad física y el estado de salud de una persona, es muy importante para ajustar el cálculo de la necesidad nutricional para cada individuo. La TMB es la mínima cantidad de energía que un organismo requiere para estar vivo. Constituye del 60 al 70% del GETD en la mayoría de los adultos sedentarios, en tanto, en los individuos físicamente muy activos es de aproximadamente el 50%. Varía dependiendo de la composición corporal, especialmente de la masa corporal magra. El metabolismo basal expresado como TMB, es diferente a la tasa metabólica en reposo (TMR) o Gasto Energético en Reposo (GER); este último se obtiene cuando la determinación se hace en reposo y en las condiciones descritas para pero no en ayuno, incluyendo por tanto la energía utilizada para el aprovechamiento biológico de los alimentos. Habitualmente, el GER se determina por medio de diferentes técnicas como la calorimetría indirecta, la bioimpedancia eléctrica, el agua doblemente marcada, las ecuaciones predictivas, entre otras. Estos métodos son utilizados en la práctica clínica y en estudios científicos. Sin embargo, debido a la inconsistencia de los resultados de estas investigaciones, todavía no hay un consenso respecto a su aplicabilidad aunque la evidencia señala que la medición del consumo de oxígeno, es el método de mayor precisión. Objetivos: Esta revisión tiene como objetivo exponer los componentes del gasto energético en reposo, así como las técnicas para su determinación y estimación, señalando sus ventajas, limitaciones y aplicaciones prácticas. Resultados: Parte de las técnicas de evaluación del gasto energético descritas en esta revisión, quedan relegadas, por su complejidad y coste al ámbito de la investigación. Durante mucho tiempo la calorimetría indirecta, quedó también restringida a este campo. Sin embargo, los avances tecnológicos han permitido el desarrollo de equipos precisos ligeros y asequibles que permiten que en la actualidad sea un método muy útil en el espacio clínico de la determinación del GER (AU)

The energetic expense daily total of an individual (EEDT) represents the energy that the organism consumes. It is constituted by the sum of: metabolic basal rate (MBR), termogenesis endogenous (TE) and energetic expense linked to the physical activity (EEPA). The determination of the EEDT considering the physical activity and the state of health of a person, it is very important to fit the calculation of the nutritional need for every individual. The MBR is the minimal quantity of energy that an organism needs to be alive. It constitutes a from 60 to 70% of the EEPA in the majority of the sedentary adults, while, in the physically very active individuals it is of approximately 50%. It changes depending on the corporal composition, specially on the corporal lean mass. The basal metabolism expressed as MRB, it is different from the metabolic rate in rest (MRR) or Resting energy expenditure (REE); the latter is obtained when the determination is done in rest and in the conditions described for the MRB but not in fasting, including therefore the energy used for the biological utilization of the food. Habitually, the REE decides by means of different technologies as the indirect calorimetry, the electrical bioimpedancy, the doubly marked water, the predictive equations, between others. These methods are used in the clinical practice and in scientific studies. Nevertheless, due to the inconsistency of the results of these researches, still there is no a consensus with regard to his applicability though the evidence indicates that the measurement of the consumption of oxygen, it is the method of major precision. Aims: This review has as aim expose the components of the energetic expense in rest, as well as the technologies for its determination and estimation, indicating its advantages, limitations and practical applications. Results: Part of the technologies of evaluation of the energetic expense described in this review, they remain relegated, for its complexity and cost to the area of the investigation. For a long time the indirect calorimetry, she remained also restricted to this field. Nevertheless, the technological advances have allowed the development of precise light and attainable equipments that allow that at present it should be a very useful method in the clinical space of the determination of the REE (AU)

Long-term efficacy of laparoscopic cholecystectomy for the treatment of biliary dyskinesia.

BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for biliary dyskinesia; however, long-term outcomes remain unclear. METHODS: A retrospective review of patients diagnosed with biliary dyskinesia and treated with laparoscopic cholecystectomy at a single institution between 2001 and 2012 was conducted. Long-term outcome data were obtained by telephonic interview using a modified Likert scale. RESULTS: Sixty-seven patients met inclusion criteria, of which 34 patients (51%) had long-term follow-up data. Mean time of follow-up was 65 (range: 6 to 134) months. Long-term follow-up demonstrated symptom response in 88% (n = 30) of patients (responders), compared to no response in 12% (n = 4) of patients (nonresponders). Responders underwent a mean of 1.56 preoperative diagnostic procedures, compared to 2.5 for nonresponders (P = .01). CONCLUSION: This represents the longest mean time of follow-up study demonstrating the success of laparoscopic cholecystectomy to improve symptoms in patients with biliary dyskinesia.