El Servicio de Mediación de Salud Pública con la Comunidad Gitana en la Comunidad de Madrid / The public health mediation service with the Roma community in the community of Madrid

El pueblo gitano presenta desigualdades sociales que generan peores resultados en salud que el conjunto de la población española. Se describe el proceso de creación del Servicio de Mediación de Salud Pública con la Comunidad Gitana, pionero en la Consejería de Sanidad de la Comunidad de Madrid, mostrando sus competencias dirigidas a disminuir dichas desigualdades. Los resultados de su trabajo, enmarcado en la praxis de la mediación intercultural y la intervención comunitaria, validan la necesidad de contar con profesionales de la mediación intercultural en salud pública. (AU)

The Roma people have social inequalities that lead to worse health outcomes than the Spanish population as a whole. We report the process to create the Public Health Mediation Service with the Roma Community, pioneer in the Community of Madrid Health Department. We also reveal its competences aimed at reducing said inequalities. The results of its work, framed in the practice of intercultural mediation and community intervention, validate the need for intercultural mediation professionals in the field of public health. (AU)

Suplementos de carbohidratos durante un ejercicio: efectos sobre los electrólitos y glucosa / Supplements of carbohydrates long during exercise: effects on the electrolytes and glucose

Objetivo: Identificar si la forma de presentación de los suplementos de carbohidratos (SC) influye en la respuesta de la concentración plasmática de electrólitos y glucosa durante un ejercicio de larga duración. Doce hombres realizaron cuatro pruebas de 90 min en cicloergometro (55-60%VO2máx), seguidas por 6 km a máxima velocidad, consumiendo SC en diferentes presentaciones (líquido, gel o sólido) y un día únicamente consumían agua. Se analizaron las concentraciones de sodio, potasio y glucosa en sangre antes del ejercicio, cada 30 minutos de prueba, y tras los 6 km. No hubo diferencia significativa en la respuesta de los electrolitos durante todo estudio. Hubo diferencias significativas (p<0,05) en la glucosa cuando se consumieron SC independientemente de su presentación frente al consumo exclusivo de agua. Se concluye que la forma de presentación de los SC no influye en la concentración de glucosa en sangre durante el ejercicio de larga duración

Objective: To identify if the format of carbohydrate supplements (CS) influence the response of the plasmatic concentration of electrolytes and glucose during long duration exercise. Twelve men performed four tests of 90 min on a cycle ergometer (55-60% VO2max), followed by 6 km at maximum speed, consuming CS in different forms (liquid, gel or solid) and one day just consuming water. It was analyzed the concentrations of sodium, potassium and blood glucose before exercise, every 30 minutes of test, and after 6 km. There was no significant difference in the response of electrolytes during the study. However, the glucose showed significant differences (p <0.05) when it was consumed CS regardless of their form, whenever just water was consumed. In this way is possible to conclude, that the format of the SC does not affect the blood glucose concentration during long duration exercise

Effectiveness of an educational group intervention in primary healthcare for continued exclusive breast-feeding: PROLACT study.

BACKGROUND: The World Health Organization leads a global strategy to promote the initiation and maintenance of breast-feeding. Existing literature shows that education and supportive interventions, both for breast-feeding mothers as well as for healthcare professionals, can increase the proportion of women that use exclusive breast-feeding, however, more evidence is needed on the effectiveness of group interventions. METHODS: This study involves a community-based cluster randomised trial conducted at Primary Healthcare Centres in the Community of Madrid (Spain). The project aims to evaluate the effectiveness of an educational group intervention performed by primary healthcare professionals in increasing the proportion of mother-infant pairs using exclusive breastfeeding at six months compared to routine practice. The number of patients required will be 432 (216 in each arm). All mother-infant pairs using exclusive breastfeeding that seek care or information at healthcare centres will be included, as long as the infant is not older than four weeks, and the mother has used exclusive breastfeeding in the last 24 h and who gives consent to participate. The main response variable is mother-infant pairs using exclusive breast-feeding at six months. Main effectiveness will be analysed by comparing the proportion of mother-infant pairs using exclusive breast-feeding at six months between the intervention group and the control group. All statistical tests will be performed with intention-to-treat. The estimation will be adjusted using an explanatory logistic regression model. A survival analysis will be used to compare the two groups using the log-rank test to assess the effect of the intervention on the duration of breastfeeding. The control of potential confounding variables will be performed through the construction of Cox regression models. DISCUSSION: We must implement strategies with scientific evidence to improve the percentage of exclusive breast-feeding at six months in our environment as established by the WHO. Group education is an instrument used by professionals in Primary Care that favours the acquisition of skills and modification of already-acquired behaviour, all making it a potential method of choice to improve rates of exclusive breast-feeding in this period. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov under code number NCT01869920 (Date of registration: June 3, 2013).

Daily oscillations of skin temperature in military personnel using thermography.

INTRODUCTION: The human body makes many physiological adjustments throughout the day, including adjustments to body temperature. The purpose of this study was to determine oscillations in the skin temperature (Tsk-1-Tsk-25) at 25 body regions of interest (ROIs) over 1 day using infrared thermography. METHODS: Tsk values of 31 male (age 22.9±3.0 years) Brazilian Air Force members were evaluated from five thermograms collected at 7, 11, 15, 19 and 23 h (Tsk7,11,15,19,23) by a Fluke imager. We applied one-way analysis of variance for repeated measures for the different times of the day and Tukey's post hoc test to determine significant Tsk differences between ROIs (α=0.05), and the cosinor analysis was used to determine the midline estimating statistic of rhythm, amplitude and acrophase of Tsk during the 24 h period. RESULTS: The anterior hands showed the greatest Tsk variations throughout the day. In the lower limbs, scapula, abdomen, chest and lower back, Tsk-11, Tsk-15, Tsk-19 and Tsk-23 were significantly different (p<0.05) from Tsk-7. The lowest Tsk values were obtained in the early morning, with increases in the afternoon and levelling after 15:00. CONCLUSIONS: The Tsk at all ROIs and the averaged Tsk showed oscillations throughout the day, with the lowest values in the early morning (07:00). Temperature fluctuations depended on the specific ROI, with thermal stabilisation in some regions in the afternoon and a central upward trend throughout the day in the hands.

Aplicaciones de la termografía infrarroja en el deporte. Una revisión / Applications of infrared thermography in sports. A review

La termografía infrarroja (TI) registra el calor irradiado de un cuerpo, que es emitido en un rango del espectro electromagnético que la visión humana no es capaz de identificar. La respuesta térmica depende de una serie de ajustes fisiológicos específicos como la homeostasis corporal y salud del deportista, lo cual permite establecer interesantes aplicaciones en el deporte. El objetivo de este trabajo ha sido revisar la literatura en torno a las aplicaciones de la TI en el ámbito del deporte, y proponer las características óptimas del registro en relación al evaluado, las condiciones ambientales y la cámara utilizada. Concluimos que la principal contribución de la TI en el ámbito del deporte es ayudar a identificar signos de lesión antes de que la lesión se produzca, permitiéndonos actuar de manera preventiva durante el proceso de entrenamiento (AU)

Infrared thermography (IRT) records the radiant heat of a body, which is emitted in the range of the electromagnetic spectrum that human vision is not able to identify. The thermal response depends on a number of specific physiological adjustments as body homeostasis and athlete’s health, which allow us to establishing interesting applications in sport. The aim of this study was to review the literature on IRT applications in sports, and to propose the optimal characteristics of the register in terms of the subject, the environmental conditions and the camera used. We conclude that the main contribution of IRT in the field of sport is to help identify signs of injury before it occurs, allowing us to act proactively along the training process (AU)

¿Puede el principio de lateralidades múltiples mejorar el porcentaje de acierto en el tiro a canasta? / ¿Pode o princípio da lateralidades várias melhorar a taxa de sucesso no arremesso para uma cesta de campo? / May the multiple dominances principle improve the percentage average in the basketball shot?

El propósito del presente estudio es determinar si una mecánica de tiro alternativa basada en la lateralidad óculo-manual del sujeto podría incrementar significativamente el porcentaje de acierto en el tiro a canasta en jugadores homogéneos - aquellos cuya lateralidad ocular y manual están en el mismo hemicuerpo lateral -. Para esto, 34 jugadores de baloncesto (24 chicos y 10 chicas) en categoría infantil, inscritos todos ellos en categoría Preferente masculino y femenino Federado, realizaron un total de 4600 lanzamientos a canasta desde cinco posiciones diferentes de corta y media distancia - 2300 con cada una de las dos mecánicas propuestas (mecánica tradicional y tiro con rotación de 45º) -. Tras el análisis de datos se hallaron porcentajes de acierto significativamente mayores desde el tiro libre (t(23) = 2,917; p = 0,008), los lanzamientos desde el lado izquierdo de la zona (t(23) = 3,621; p = 0,001) y el global de los lanzamientos a canasta (t(23) = 3,980; p = 0,001) con la mecánica de tiro teóricamente idónea. Los resultados obtenidos sustentan que una mecánica de tiro alternativa basada en la lateralidad óculo manual del jugador podría ayudar a los jugadores de baloncesto homogéneos a obtener porcentajes de acierto significativamente superiores (AU)

o objetivo deste estudo é determinar se uma mecânica de lançamento alternativa com base na lateralidade oculo-manual incrementa significativamente a taxa de sucesso no lançamento de basquetbol em jogadores homógeneos. Neste estudo participaram, 34 jogadores de basquetebol (24 rapazes e 10 raparigas), do escalão infantil, todos eles inscritos na liga de categoria Preferente masculino e Federado feminino, os atletas realizaron um total de 4600 lançamentos ao cesto de cinco posições diferentes de curta e média distância - 2300 com cada um dos duas propostas mecânicas (mecânica tradicional e lançamento com rotação de 45º) -. Após a análise dos dados verificou-se porcentagens elevadas de sucesso nos lançamentos livres (t(23) = 2.917, p = 0,008), nos lançamentos do lado esquerdo (t(23) = 3.621; p = 0,001) e na totalidade dos lançamentos ao cesto (t(23) = 3.980; p = 0,001) com a mecânica de lançamento teoricamente adecuada. Os resultados optidos sustentan que uma mecânica de lançamento com base na lateralidade oculo-manual do jogador poderia ajudar aos atletas de basquetebol homogenios a obter percentagens de sucesso no lançamento significativamente maiores (AU)

The purpose of the present study is to determine if a basketball shot mechanic based on the eye-hand laterality of the subject may produce a statistically significant increase in the average percentage in the basketball shot in homogeneous players - those whose hand and eye dominance are in the same body lateral -. To achieve this, 34 basketball players (24 boys and 10 girls) in U14 category, all of them registered in Preferente Masculino or Femenino Federado, made 4600 shots from 5 different positions of short and medium range - 2300 shots with both mechanics proposed (traditional mechanic and 45º rotation shot) -. In the data analysis statistical significant differences were found in the free throw shots (t(23) = 2,917; p = 0,008), the zone’s left-side throws (t(23) = 3,621; p 0= 0,001) and in the total of the basketball shots (t(23) = 3,980; p = 0,001) with the shot mechanic theoretically ideal. The results obtained support that an alternative basketball shot mechanic based on the eye-hand laterality of the homogeneous players may help them to obtain average percentages significantly higher (AU)

An examination of injuries in Spanish Professional Soccer League.

AIM: Objective of the study was to examine the injury incidence in the Spanish Professional Soccer League, and to analyse differences between competition and training. METHODS: Sport injuries data from 11 out of 22 Spanish second division soccer teams (301 players) were prospectively collected during the season 2008/2009. RESULTS: A total of 891 injuries (111 recurrence injuries) were identified during 161602.7 hours of exposure. Competition injury incidence was higher than training (38.8 vs. 3.8 injuries per 1000h; P<0.05). The higher injury incidence was located at lower extremities (4.82 per 1000 h), and mainly affected muscles and tendons (3.1 per 1000 h). Two out of three injuries were due to overuse (54% during competition and 72% during training), and mainly result in players were unable to full soccer participation for less than 7 days (64%). Training injury incidence was higher during the pre-season and tended to decrease throughout the season (P<0.05), while competition injury incidence increased progressively throughout the season (P<0.05). CONCLUSION: In our best knowledge, this is the first examination of injuries in Spanish professional soccer players. The main findings of the study suggest that competition is much more injurious than training, revealing a progressive decrease of training injury incidence and a progressive increase of competition injury incidence throughout the season. These data might be considered by clubs, coaches, and medical staff in order to design new strategies that reduce injury risk in Spanish Professional Soccer League.

Thermographic profile of soccer players' lower limbs / Perfil termográfico de los miembros inferiores en jugadores de fútbol

Objective. The objective of this study was to establish the thermographic profile of the lower limbs in elite young soccer players. Method. One hundred soccer players from the U-19 categories of a first division Brazilian football club (15.5 ± 1.37 years; 67.93 ± 9.62 kg; 177.49 ± 8.67 cm) participated in the study. Two thermograms allowed us to record maximum and average skin temperatures (TSK) in four body regions of interest (ROIs) of the lower limbs corresponding to the anterior and posterior view of the leg and thigh. The Wilcoxon test was used to compare bilateral TSK differences with a significance level of α < 0.05. Results. Average values of TSK in the anterior view were as follows: right thigh 30.2 ± 1.9°C, left thigh 30.2 ± 1.9°C, right leg 29.8 ± 1.8°C, and left leg 29.9 ± 1.8°C. In the posterior view, the values were as follows: right thigh 30.3 ± 1.8°C, left thigh 30.2 ± 1.8°C, right leg 29.6 ± 1.9°C, and left leg 29.4 ± 1.9°C. The statistical analysis did not show significant differences between sides in the selected ROIs for average or maximum temperatures. A histogram of TSK frequencies for each ROI allowed establishment of values for hyper-and hypothermia. Conclusion. The elite young soccer players analyzed showed contralateral thermal symmetry. The average TSK differences for paired ROIs were each ≤ 0.2°C. Each ROI exhibited a specific thermal profile. The registered TSK indicated a normal thermal profile of the athletes (AU)

Objetivo. El objetivo de este estudio es establecer el perfil termográfico de los miembros inferiores en jóve-nes jugadores de fútbol de élite. Método. En el estudio participaron 100 jugadores de fútbol de categorías sub-19 de clubes de fútbol brasileños de primera división (15,5 ± 1,37 años; 67,93 ± 9,62 kg; 177,49 ± 8,67 cm). Mediante dos termogramas se obtuvieron las temperaturas máximas y medias de la piel (TSK) de cuatro regiones corporales de interés (RDI) correspondientes a la vista anterior y posterior de la pierna y del muslo. Se empleó el test de Wilcoxon para comparar las diferencias de la TSK bilateral, con un nivel de significación α < 0,05. Resultados. Los valores medios de la TSK en la vista anterior fueron los siguientes: muslo derecho 30,2 ± 1,9°C, muslo izquierdo 30,2 ± 1,9°C, pierna derecha 29,8 ± 1,8°C y pierna izquierda 29,9 ± 1,8°C. En la vista posterior, los valores fueron los siguientes: muslo derecho 30,3 ± 1,8°C; muslo izquierdo 30,2 ± 1,8°C; pierna derecha 29,6 ± 1,9°C y pierna izquierda 29,4 ± 1,9°C. El análisis estadístico no mostró diferencias significativas en las temperaturas medias o máximas tomadas en las RDI elegidas. Un histograma de las frecuencias de TSK para cada RDI permitió establecer valores para hiper e hipotermia. Conclusión. Los jóvenes jugadores de fútbol de élite analizados mostraron simetría térmica contralateral. La TSK media para pares de RDI era para cada uno ≤ 0,2°C. Cada RDI mostró un perfil térmico específico. La TSK mostró un perfil térmico normal de los atletas (AU)

Avaliação da temperatura da pele durante o exercício através da termografia infravermelha: uma revisão sistemática / Evaluation of skin temperature during exercise by infrared thermography: a systematic review

Objetivo. Describir los cambios en la temperatura de la piel (Tp) durante el ejercicio registrado por medio de termografía infrarroja. Método. Se realizó una revisión sistemática de la literatura utilizando los términos ejercicio y termografía en las bases de datos de MEDLINE/PubMed, IEEEXplore y SciELO teniendo como principales factores de inclusión, estudios con humanos sin ningún tipo de problema físico o metabólico. Resultados. Tras el proceso de exclusión, fueron seleccionados ocho artículos. La Tp tiende a disminuir al inicio del ejercicio, de manera que su magnitud depende de la duración e intensidad de la actividad propuesta. En ejercicios con carga progresiva se observa una continua reducción de la Tp en comparación con los valores de reposo. Sin embargo, en ejercicios prolongados, la Tp puede variar según la región corporal evaluada con reducción, mantenimiento o incluso un aumento térmico, como sucede en las principales regiones musculares involucradas en el ejercicio. La Tp presenta respuestas específicas durante el ejercicio en función de la región corporal y la necesidad de pérdida de calor. Conclusión. La Tp disminuye en la fase inicial del ejercicio. La manera de realizar el ejercicio de perfil máximo o submáximo determina la respuesta de la Tp. No existe una respuesta homogénea en la Tp entre las diferentes regiones corporales, demostrando así la extremada complejidad del proceso de control de la temperatura central. Consecuentemente, la termografía infrarroja puede ser un valioso instrumento para hacer un seguimiento tanto de la respuesta térmica local como de la general(AU)

Objective. To describe the changes on Skin Temperature (Tsk) during exercise through Infrared Thermography. Method. A systematic review of the current literature was made, using the keywords "exercise" and "thermography" on the database MEDLINE/PubMed, IEEEXplore and SciELO. The research was made including the articles done with healthy humans without any physical or metabolic impairment. Results. After the exclusion process eight articles were selected. Tsk was has the tendency to decrease at the beginning of the exercise, depending on the duration and intensity of the task. In graded exercises a continuous reduction on Tsk was observed. Nevertheless, a bigger duration could lead to different thermal responses depending on the body area: reduction, maintenance or even an increase on the main regions involved on the exercise. Tsk has specific thermal responses depending on the body region and the heat loss necessities. Conclusion. Tsk decreases during the early stages of exercise. The thermal response will depend on the way of doing the maximal or submaximal exercise. There is a heterogeneous thermal response of Tsk between the different body regions, showing the extremely complexity of body temperature control. Therefore, Infrared Thermography could be a valuable tool in order to monitor both the local or the main thermal responses(AU)

[Go to the health center or go to the drug store? Pharmacy offices as a primary care resource]. / Ir al centro de salud o bajar a la farmacia? Las oficinas de farmacia como recurso de atención primaria.

OBJECTIVE: To find what the pharmacy office represents socially to the population that uses it most. DESIGN: Qualitative study. Analysis of the contents of two discussion groups. PARTICIPANTS: Women from 30 to 60 years old, urban residents of the Community of Madrid. MEASUREMENTS AND MAIN RESULTS: The pharmacy offices were identified by the user as a primary care resource which was accessible--both because of its closeness and opening hours--and trustworthy. They provided health care support for treating minor ailments ("assisted self-medication") and also advised on medical technicalities and use of medication. Users with potentially serious clinical pictures were referred from the pharmacy to the doctor. The images associated with "going to the doctor" lacked the nearness and familiarity of "dropping round to the pharmacy". CONCLUSIONS: Integrating pharmacy office pharmacists into a general primary care framework would improve the health of the general population.

¿Ir al centro de salud o bajar a la farmacia? Las oficinas de farmacia como recurso de atención primaria / Go to the health centre or drop round to the chemist's? pharmacy offices as a primary health care resource

Objetivo. Conocer las representaciones sociales que sobre la oficina de farmacia tiene la población más frecuentadora. Diseño. Estudio cualitativo. Análisis del discurso producido por 2 grupos de discusión. Participantes. Mujeres de 30-60 años, residentes urbanas de la Comunidad de Madrid. Mediciones y resultados principales. Las oficinas de farmacia son identificadas por el usuario como un recurso de atención primaria accesible -tanto por su cercanía como por sus horarios- y de confianza. En ellas se realiza una actividad asistencial de apoyo para el tratamiento de dolencias menores ('automedicación asistida'), y por otro lado se aconseja sobre tecnicismos médicos y sobre el uso de la medicación. Desde la farmacia se deriva al médico a los usuarios con cuadros potencialmente graves. Las imágenes asociadas a 'ir al médico' carecen de la cercanía y familiaridad que se asocia a 'bajar a la farmacia'. Conclusiones. La integración de los farmacéuticos de la oficina de farmacia dentro de un marco global de atención primaria supondría una mejora para la salud de la población (AU)