Importancia de la investigación sobre políticas y sistemas de salud para el fortalecimiento de la rehabilitación en los sistemas sanitarios. Un llamado a la acción para acelerar el progreso / Importance of health policy and systems research for strengthening rehabilitation in health systems. A call to action to accelerate progress.

Durante las últimas décadas, el campo de la rehabilitación ha experimentado un desarrollo, crecimiento y aceptación sustanciales. La rehabilitación es un conjunto de intervenciones que aborda el impacto de una afección médica en la vida cotidiana de una persona de tal manera que optimiza su funcionamiento y reduce su experiencia de discapacidad. Del mismo modo, la rehabilitación amplía el enfoque de la salud más allá de la atención preventiva y curativa para garantizar que las personas con un problema de salud puedan continuar siendo lo más independientes posible y participando en la educación, el trabajo y los roles significativos de la vida1. Recientemente se ha publicado una definición de rehabilitación para fines investigativos2. La investigación científica y clínica ha generado un cúmulo de conocimientos que respaldan firmemente el uso de muchas intervenciones de rehabilitación con resultados positivos en diversas poblaciones y problemas de salud.

Over the past few decades, the field of rehabilitation has experienced substantial development, growth and acceptance. Rehabilitation is a set of interventions that addresses the impact of a medical condition on a person's daily life in a way that optimizes their functioning and reduces their experience of disability. Similarly, rehabilitation broadens the focus of healthcare beyond preventive and curative care to ensure that people with a health condition can continue to be as independent as possible and participate in education, work and meaningful life roles1. A definition of rehabilitation has recently been published for research purposes2. Scientific and clinical research has generated a body of knowledge that strongly supports the use of many rehabilitation interventions with positive outcomes in a variety of populations and health problems. scientific and clinical research has generated a body of knowledge that strongly supports the use of many rehabilitation interventions with positive outcomes in a variety of populations and health problems.

Medicina física y rehabilitación durante y después de la pandemia: una breve reflexión / Physical medicine and rehabilitation during and after the pandemic: a brief reflection

La pandemia declarada por la Organización Mundial de la Salud debido ala enfermedad de lCovid-19 ha tenido un impacto considerable en todas las actividades humanas, incluyendo los sistemas de salud y todo lo relacionado con la prestación de los servicios médicos que necesita la población. Las instituciones que brindan servicios de Medicina Física y Rehabilitación (MF y R) no son la excepción y las acciones necesarias tomadas por los gobiernos han tenido una incidencia, en algunos casos ,severa en los servicios hospitalizados de rehabilitación, las clínicas ambulatorias ,los servicios de rehabilitación a nivel de la comunidad, los programas de educación médica graduada o residencia, y los esfuerzos de investigación en especial aquellos de naturaleza clínica.

The pandemic declared by the World Health Organization due to Covid-19 disease has had a considerable impact on all human activities, including health systems and everything related to the provision of medical services needed by the population. Institutions providing Physical Medicine and Rehabilitation (PM&R) services are no exception and the necessary actions taken by governments have had an impact, in some cases severe, on inpatient rehabilitation services, outpatient clinics, community-based rehabilitation services, graduate medical education or residency programs, and research efforts, especially those of a clinical nature.

Diseño de un sistema de vigilancia epidemiológica para los XVII Juegos Deportivos Centroamericanos y del Caribe, Puerto Rico, 1993 / Development of a system for epidemiologic surveillance for the XVII Central American and Caribbean Sport Games, Puerto Rico, 1993

The probability of recording infectious diseases and injuries to the musculoskeletal system during sports events with a large number of participants is very high. From an historical perspective the distribution and trends of diseases that have an impact on public health have been evaluated by means of epidemiological surveillance systems. However, the application of these epidemiological methods to sports medicine is relatively recent. The utilization of an epidemiological surveillance system during sports events with a large number of participating athletes and countries has been reported in a limited number of competitions. In this article we describe the design of a system for epidemiological surveillance utilized during the XVII Central American and Caribbean Sports Games held in Puerto Rico in 1993, as an example of a surveillance system that could be regularly established in this type of event

Descripción de la morbilidad reportada en el sistema de vigilancia epidemiológica de los XVII Juegos Deportivos Centroamericanos y del Caribe, Puerto Rico, 1993 / Description of morbidity notified in the epidemiologic surveillance system of XVII Central American and Caribbean Sport Games, Puerto Rico, 1993

The objective of the epidemiological surveillance system for the XVII Central American and Caribbean Sports Games in 1993 in Puerto Rico was to estimate the morbidity related to infectious diseases and sports injuries during the competitions. In the village hospital a total of 794 medical consultations were reported; 57.7 per cent of the patients were athletes. Among athletes, the rate of consultation was 10.4 for every 100 participants. The consultations were more frequent in males (535, 67.4 per cent ). The analysis by country of origin revealed that the athletes from Guatemala (42, 9.2 per cent ) and Jamaica (35, 7.6 per cent ) used the services more frequently. The incidence of consultations by sport was higher in field hockey (47, 10.3 per cent ), followed by athletics (46, 10 per cent ), and softball (36, 7.9 per cent ). The most frequent diagnoses were injuries--302, 38.04 per cent ; of these 229 (75.8 per cent ) were athletes--,conditions of the respiratory system (180, 22.67 per cent ), problems of the skin and mucous membranes (85, 10.71 per cent ), and problems of the gastrointestinal tract (56, 7.05 per cent ). The severity of the majority of the conditions was mild and required primary care health professionals

Perfil de utilización de los servicios de salud durante los XVII Juegos Deportivos Centroamericanos y del Caribe: Delegación de Puerto Rico, Ponce 1993 / Profile of health services utilization during the XVII Central and Caribbean Sport Games: Delegation of Puerto Rico, Ponce 1993

During the XVII Central American and Caribbean Sports Games held in Ponce in 1993 the health services offered to the Puerto Rico Delegation included medical, dental and psychological assistance, physical therapy and services on the playing field. Information about the use of these services was obtained from the encounter sheets. The Puerto Rican delegation of 750 members had 1,800 encounters with the health team; 612 (34.0 per cent ) individual consults; 896 (54.8 per cent ) physical therapy sessions; 166 (9.2 per cent ) encounters in the sports venues; and 36 (20 per cent ) group therapies. The most common diagnoses were athletic injuries (304; 58.2 per cent ) and diseases of the respiratory system (76; 14.5 per cent ). The most frequent athletic injuries were first degree strains (75; 24.7 per cent ) and tendinitis (73, 24.0 per cent ). This pattern is similar to that observed in other sports games and delegations with mild conditions prevailing. An interdisciplinary work and biopsychosocial approach will be important for the better health and performance of our athletes

Patterns of injuries in athletes evaluated in an interdisciplinary clinic

The pattern of sports injuries appears to be population-specific. The purpose of the present study is to describe 1750 injuries evaluated between April 1988 and April 1994 in our Olympic Training Center Interdisciplinary Sports Injury Clinic. Our patient population included elite and recreational athletes of both sexes between the ages of 7 and 71 years. Males comprised 73 per cent of the patient population and approximately 80 per cent of the injuries corresponded to the 10 to 29 age range. The most frequent sports in males were baseball (21.9 per cent ) and basketball (15.9 per cent ) and in females were track and field (17.1 per cent ) and gymnastics (15.1 per cent ). Most injuries (52 per cent ) were traumatic in nature, chronic (71.6 per cent ), and occurred during training sessions (57.4 per cent ). The most commonly affected anatomical areas were the knee (31.2 per cent ) and shoulder (15.5 per cent ). The most common diagnoses were tendinitis (25.4 per cent ), and first degree strains (11.8 per cent ) and sprains (9.3 per cent ). Finally, treatment strategies included medications (61.0 per cent ), physical therapy (48.9 per cent ), relative rest (35.7 per cent ), and home exercise programs (35.2 per cent ). The variety of musculoskeletal disorders seen in combination with the frequent use of conservative treatment confirms the importance of an interdisciplinary approach to sports injuries

Morbilidad durante los XVI Juegos Deportivos Centroamericanos y del Caribe: Delegación de Puerto Rico, México 1990 / Morbidity during the XVI Central American and Caribbean Games: Puerto Rico delegation, Mexico 1990

The health services offered to the Puerto Rican Delegation during the XVI Central American and Caribbean Sports Games in México in 1990 included: medical, dental and psychological assistance, physical therapy and services on the playing field. From the consultation sheets completed during the Games we obtained information about the use of these services. The 336 members of the Puerto Rico Delegation in the village at México City had 1,838 encounters with the health team. Of these, 991 were medical consults, 55 group therapies, 466 physical therapy sessions and 326 encounters in the sports venues. Among the encounters for medical evaluation the most frequent problems were athletic injuries (318; 32.1 percent), respiratory problems (240; 24.2 percent), gastrointestinal conditions (126; 12.7 percent) and dental services (119; 12.0 percent). The most frequent athletic injuries were first degree strains (83; 26.1 percent), tendinitis (56; 17.6 percent), contusions (42; 13.2 percent), myositis (40; 12.6 percent) and first degree sprains (28; 8.8 percent). The health problems found were diversed and in the majority of cases mild in character, which can be attend by adequately trained on sports health primary health professionals

Función pulmonar en atlelas puertorriqueños de alto rendimiento

El perfil fisiológico del atleta de alto rendimiento ilustra las adaptaciones que el entrenamiento prolongado y la influencia genética pueden producir en el cuerpo humano. Las pruebas defunción pulmonar son parte de dicho perfil y han sido utilizadas pra evaluar el estado de salud y el nivel de aptitud física de los deportistas. En este trabajo se describen algunas variables de función pulmonar en atletas puertorriqueños de alto rendimiento. La población fue estraficada tomando en consideración las características técnicas y metabólicas de los diferentes deportes. Utilizando la clasificación técnica, el análisis estadístico revela que solo el grupo deportivo de coordinación y arte competitivo (deportes como gimnasia, velas, tiro) tiene valores significativamente menores para las variables FVC/estatura (P = 0.003) y FEV1 (p = 0.014). Dichas diferencias desparecen al clasificar los deportes de acuerdo a las demandas energéticas en aeróbico, anaeróbico o combinado. Estos resultados sugieren que las clasificaciones deportivas actuales no distinguen atletas por diferencias en la función pulmonar en reposo. Es posible que las variables analizadas en este estudio no sean buenos indicadores del estado de entrenamiento de estos atletas

El uso y abuso de sustancias prohibidas en el deporte

Se han presentado y discutido las definiciones, clasificaciones y ejemplos específicos de sustancias prohibidas y no prohibidas en el deporte. Se discutió el problema de la detección de sustancias y el papel de los laboratorios y las metodologías usadas en la deteccón. Finalmente, se trató el asunto de la prevención, el tratamiento y la rehabilitación desde la perspectiva del modelo biopsicosocial de la medicina