Psychometric properties of the Providers Survey in the Brazilian context of mental health: a validation study

ABSTRACT BACKGROUND: Precisely determining the aspects related to an instrument's validity and reliability measures allows for greater assurance of the quality of the results. OBJECTIVES: To analyze the psychometric properties of The Providers Survey in the Brazilian context of mental health services. DESIGN AND SETTING: The instrument validation study was conducted in Montes Claros, Minas Gerais, Brazil. METHODS: The validation study was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist to analyze its validity and reliability. RESULTS: A committee of expert judges performed content validation after which the Content Validity Index was calculated. Construct validation took place through Exploratory Factor Analysis using the Kaiser-Meyer-Olkin Test criterion and Bartlett's Sphericity Test. Reliability was verified using test-retest reliability. The significance level adopted for the statistical tests was 5% (P < 0.05). The final instrument comprised 54 questions. The Content Validity Index was 97%. Exploratory Factor Analysis identified a Kaiser-Meyer-Olkin index of 0.901 and Bartlett's Sphericity Test with P < 0.001. We obtained a Cronbach's alpha coefficient of 0.95 and an intraclass correlation coefficient of 0.849. CONCLUSIONS: The Providers Survey, translated and adapted into Portuguese, was named the Work Assessment Instrument for the Recovery of Mental Health. It presented adequate psychometric properties for evaluating work-related practices for the recovery of psychosocial care network users.

The impact of inclusion practices on the identity of people diagnosed with severe mental illness: Radio Nikosia / O impacto das práticas de inclusão na identidade de pessoas diagnosticadas com doença mental grave: Radio Nikosia

Abstract This article examines the discursive approach adopted by Radio Nikosia, highlighting its crucial role in the recovery of people diagnosed with severe mental illness. It examines how putting social representations aside has enabled Radio Nikosia to render agency to these social actors, acknowledging their capacity to construct, reconstruct and change their own identities. The geographic scope of the study comprises the Autonomous Community of Catalonia while the methodology followed is qualitative in nature, analysing programme audio and transcription, reports, academic articles, theses, and a participant interview. The aim of the analysis is to examine the significance of discursive practices in Radio Nikosia in modifying the permanence of identities anchored in severe mental illness. The results illustrate the practical use of radio as a powerful tool that both promotes social inclusion and impacts mental illness identity.

Resumo Este artigo examina a abordagem discursiva adotada pela Rádio Nikosia, destacando seu papel crucial na recuperação de pessoas diagnosticadas com doença mental grave. Examina como deixar de lado as representações sociais permitiu à Rádio Nikosia dar agência a esses atores sociais, reconhecendo sua capacidade de construir, reconstruir e mudar suas próprias identidades. O escopo geográfico do estudo compreende a Comunidade Autônoma da Catalunha, enquanto a metodologia seguida é de natureza qualitativa, analisando áudio e transcrição do programa, relatórios, artigos acadêmicos, teses e entrevista participante. O objetivo da análise é examinar o significado das práticas discursivas da Rádio Nikosia na modificação da permanência de identidades ancoradas na doença mental grave. Os resultados ilustram o uso prático do rádio como uma ferramenta poderosa que promove a inclusão social e impacta a identidade da doença mental.

Exponential modelling of heart rate recovery after a maximal exercise

Objectives: Heart rate recovery (HRR) after exercise is clinically important as a predictor of mortality. In addition, HRR is an indicator of cardiac autonomic activity, since increased vagal activity and diminished sympathetic activity return the heart rate to resting conditions after exercise. The previous attempts to model HRR using polynomial, first-order and second-order modelling have produced mixed results. In this study, we hypothesised that the double-exponential fit would model the HRR more accurately than the single-exponential fit as it would capture the activity of both autonomic arms responsible for heart rate decay and investigated the outcome of these two models on the HRR data following a maximal exercise. Materials and Methods: Exponential curve fitting was done on a set of previously published data from our laboratory. The HRR data were acquired from 40 male participants (19–38 years) after a maximal treadmill exercise. The normalised HRR data from a 5-min time window from maximal heart rate were fitted using single and double-exponential curves, to obtain, respectively, the time constants Tau and, Tau 1 and Tau 2. The goodness-of-fit of the model was assessed with Chi-square values computed for each participant data set with both models. Considering that Chi-square of zero is a perfect fit, and therefore, smaller Chi-square values indicate a better fit than larger values, we computed the difference in the Chi-square values (??2 ) between the models by subtracting the Chi-square value of the double-exponential fit from the Chi-square value of the singleexponential fit. This was based on the premise that if the calculated ??2 is positive, it would indicate a better fit with double-exponential than single-exponential decay model. The data are presented as mean ± standard deviation. Comparisons were made with Student’s t-test. Results: Data from four participants were excluded for technical reasons. The Tau of the single-exponential fit was 65.50 ± 12.13 s, while Tau 1 and Tau 2 of the double-exponential fit were 43.75 ± 18.96 s and 120.30 ± 91.32 s, respectively, the Tau 1 value being significantly lower than the Tau 2 value (P < 0.0001). Remarkably among the 36 participants, the difference in the Chi-square value was positive (127.2 ± 171.04) in 22 subjects and zero or marginally negative (?0.17 ± 0.31) in 14 subjects. Conclusion: Our results indicate that the double-exponential model fitted the HRR data better than the single-exponential model in almost two-thirds (61%) of our study population. In the remaining participants, the goodness-of-fit was nearly equivalent for both fits with no evidence of superior modelling with the singleexponential fit. Our data show that while the single-exponential fit is sufficient for modelling the HRR of 14 subjects, it was less efficient for fitting the data of most participants. In comparison, the double-exponential curve fit effectively modelled 100% of our study population. Given our findings, we conclude that the doubleexponential model is more inclusive and better represented the HRR data of our study population than the singleexponential model.

Heart rate recovery at 1st min after graded exercise an indicator of parasympathetic function in healthy obese young adults

Background: Heart rate recovery at 1st min (HRR 1 min) after graded treadmill exercise (GTX) is a predictor of parasympathetic function. Impaired HRR 1 min and obesity are strong predictors of metabolic syndrome and cardiovascular disorders. This study is done to asses HRR 1 min on apparently healthy obese young adults with body mass index (BMI) ?30, without any other metabolic syndrome components. Aims and Objectives: The objective of this study was to assess the parasympathetic function by estimating HRR 1 min after exercise in apparently healthy obese young adults of 18–30 years of age without any metabolic syndrome components and is compared with age- and gender-matched controls with normal BMI. Materials and Methods: Fifty obese young adults with BMI ?30 without any other metabolic syndrome component and 50 age- and gender-matched controls with BMI ?24.9 were selected and subjected to GTX according to modified Bruce protocol. Maximum heart rate reached during exercise (HRmax) and heart rate at 1st min of recovery phase (HR1min) were recorded. HRR 1 min was calculated as HRmax-HR1min and was analyzed. Results: This study showed significantly attenuated HRR 1 min in obese young adults compared to age- and gender-matched controls (mean 24.02 ± 8.87 vs. 42.42 ± 5.3, P < 0.001). Conclusion: HRR 1 min was significantly decreased in obese young adults, indicating attenuated parasympathetic function, who are at higher risk of developing chronic cardiovascular and other metabolic disorders.

Bloqueo interescalénico en el contexto de la recuperación acelerada para artroscopía de hombro: serie de casos / Interscalene block in the context of enhanced recovery for shoulder: A case series

Introducción La aplicación de la recuperación acelerada en cirugía de hombro no ha tenido una aceptación tan favorable. Por ello, el objetivo de este estudio fue presentar y describir el uso de bloqueo interescalénico para favorecer la recuperación acelerada en una serie de pacientes sometidos a cirugía artroscopica de hombro. Métodos Se incluyeron 35 pacientes sometidos a cirugía artroscópica de hombro, en quienes se administró bloqueo interescalénico y sedación. Posteriormente se evaluó la intensidad del dolor, náuseas, vómito, disnea, presencia de síndrome de Horner, visión borrosa, ronquera, tiempo transcurrido hasta el alta, reingresos no planeados, satisfacción del paciente y cumplimiento de los criterios de alta hospitalaria en las primeras 12 horas siguiendo los criterios de una recuperación acelerada. Resultados En total, 27 pacientes (77,1%) tuvieron clasificación de la (ASA) I y 8 pacientes (22,9%) ASA II. Además, 97,1% fueron reparaciones de manguito rotador. Previo al alta, dos pacientes (5,7%) presentaron náuseas. Al momento del alta ningún paciente presentó disnea o visión borrosa, dos pacientes (5,7%) presentaron ronquera y la mediana de intensidad del dolor fue de 1,0 (0,0 a 7,0). Entre las 24 y 48 horas solo un (2,8%) paciente presentó náuseas y la mediana de intensidad del dolor fue de 1,0 (0,0 a 8,0). Todos los pacientes se mostraron satisfechos con disposición a repetir la experiencia. El 100% de pacientes cumplió los criterios médicos de alta a las 12 horas y 30 pacientes (85,7%) se dieron de alta el mismo día. La estancia fue de 12 (11,5 a 12,5) horas y ningún paciente reingresó. Conclusión En pacientes seleccionados, con un equipo quirúrgico-anestésico comprometido, capacitado y con experiencia, hay una alta posibilidad de que el bloqueo interescalénico favorezca la realización de programas de recuperación acelerada en cirugía artroscópica de hombro.

Introduction The application of enhanced recovery in shoulder surgery has not had such a favorable acceptance, therefore, the objective of this study was to present and describe the use of interscalene block to promote enhanced recovery in a series of patients undergoing shoulder arthroscopic surgery. Methods Thirty-five patients undergoing arthroscopic shoulder surgery were included, in whom interscalene blockade and sedation were administered. Subsequently, pain intensity, nausea, vomiting, dyspnea, presence of Horner's syndrome, blurred vision, hoarseness, time elapsed to discharge, unplanned readmissions, patient satisfaction, and compliance with hospital discharge criteria in the first 12 weeks were evaluated, hours following the criteria of an enhanced recovery. Results 27 patients (77,1%) had ASA I and 8 patients (22,8%) ASA II, 97,1% were rotator cuff repairs. Before discharge, two patients (5.7%) had nausea. At discharge, no patient had dyspnea or blurred vision, two patients (5.7%) developed hoarseness, and the median pain intensity was 1.0 (0.0-7.0). Between 24 and 48 hours only one patient (2.8%) presented nausea and the median pain intensity was 1.0 (0.0-8.0). All the patients were satisfied with their willingness to repeat the experience, 100% of the patients met the criteria for medical discharge after 12 hours, 30 patients (85.7%) were discharged the same day, the stay was 12 (11.5 to 12.5) hours, and no patient was readmitted. Conclusion In selected patients with a committed, trained and experienced surgical-anesthetic team, there is a high possibility that the interscalene block will favor the performance of enhanced recovery programs in shoulder arthroscopic surgery.

Importancia del VO2máx y la capacidad de recuperación de los futbolistas

El consumo máximo de oxígeno se considera un indicador directamente relacionado con la resistencia aeróbica, por lo que dicha capacidad se hace determinante en el rendimiento del futbolista. Conocer los criterios teóricos nacionales que sustentaron la importancia del VO2máx en la capacidad de recuperación en el fútbol constituyó un paso previo hacia conformar estrategias prospectivas de intervención directa para la toma de decisiones. En tal sentido, se planteó como objetivo de la investigación determinar, por consulta de especialistas, los criterios existentes de la importancia del VO2máx en la capacidad de recuperación de los futbolistas. La investigación fue descriptiva-correlacional de orientación exploratoria; se encuestaron a 13 especialistas que emitieron criterios sobre cinco indicadores. La importancia de la resistencia aeróbica en el entrenamiento del fútbol obtuvo un puntaje de (X4.62) y en relación al resto de las capacidades físicas aplicadas al fútbol un (X3.23); la importancia del VO2máx en el proceso de dirección un (X4.46); la correlación entre VO2máx y la recuperación un (X4.54) y la necesidad de perfeccionar la resistencia aeróbica en el fútbol ecuatoriano un (X4). El índice de concordancia entre especialistas obtuvo un nivel aceptable (w=0.527). Todos los indicadores de análisis obtuvieron una cualificación entre alta y muy alta, por lo que la investigación resaltó la importancia teórica brindada por los especialistas sobre el consumo máximo de oxígeno como indicador directamente relacionado con la resistencia aeróbica y el vínculo entre este y la capacidad de recuperación de los futbolistas.

SÍNTESE O consumo máximo de oxigênio é considerado um indicador diretamente relacionado à resistência aeróbica, tornando esta capacidade um fator determinante no desempenho de um jogador de futebol. Conhecer os critérios teóricos nacionais que sustentavam a importância do VO2max na capacidade de recuperação no futebol foi um passo anterior para a formação de estratégias prospectivas de intervenção direta para a tomada de decisões. Neste sentido, o objetivo da pesquisa foi determinar, consultando especialistas, os critérios existentes sobre a importância do VO2max na capacidade de recuperação dos jogadores de futebol. A pesquisa foi descritivo-correlacional com uma orientação exploratória; 13 especialistas foram pesquisados e deram critérios sobre cinco indicadores. A importância da resistência aeróbica no treinamento de futebol obteve uma pontuação de (X4,62) e em relação ao resto das capacidades físicas aplicadas ao futebol a (X3,23); a importância do VO2max no processo de gerenciamento a (X4,46); a correlação entre VO2max e recuperação a (X4,54) e a necessidade de aperfeiçoar a resistência aeróbica no futebol equatoriano a (X4). O índice de concordância entre especialistas obteve um nível aceitável (w=0,527). Todos os indicadores de análise obtiveram uma qualificação entre alto e muito alto, portanto a pesquisa destacou a importância teórica dada pelos especialistas sobre o consumo máximo de oxigênio como um indicador diretamente relacionado à resistência aeróbica e a ligação entre esta e a capacidade de recuperação dos jogadores de futebol.

The maximum oxygen consumption is considered an indicator directly related to aerobic endurance, so this capacity becomes decisive in the performance of the soccer player. Knowing the national theoretical criteria that supported the importance of VO2max in the recovery capacity in soccer was a previous step towards shaping prospective strategies of direct intervention for decision making. In this sense, the objective of the research was to determine, by consulting specialists, the existing criteria of the importance of VO2max in the recovery capacity of soccer players. The research was descriptive-correlational with an exploratory orientation; 13 specialists were surveyed who issued criteria on five indicators. The importance of aerobic endurance in soccer training obtained a score of (X 4.62) and in relation to the rest of the physical capacities applied to soccer a (X3.23); the importance of VO2max in the direction process a X 4.46); the correlation between VO2max and recovery a (X 4.54) and the need to improve aerobic endurance in Ecuadorian soccer a (X 4). The concordance index between specialists obtained an acceptable level (w=0.527). All the analysis indicators obtained a qualification between high and very high, so the research highlighted the theoretical importance provided by specialists on maximum oxygen consumption as an indicator directly related to aerobic endurance and the link between this and the ability to recovery of footballers.

Effect of double dose plateletpheresis on target yield and donor platelet recovery

Abstract Introduction The demand for apheresis platelets has increased in the recent past and the shrinking donor pool has shifted the trend to collection of double-dose or higher yield of platelets. Objective The present study aimed to determine the effect of double-dose plateletpheresis on the target yield and donor platelet recovery. Methods The study was conducted on 100 healthy plateletpheresis donors, 50 of whom were in the study group, which underwent double-dose plateletpheresis (DDP), and 50 of whom were in the control group for single-donor plateletpheresis. Pre- and post-procedure samples of donors were subjected to a complete blood count. The DDP product was sampled for platelet yield and then split into two parts. Platelet yield, collection efficiency, collection rate, recruitment factor and donor platelet loss were calculated. Results The mean platelet yield in the SDP was 4.09 ± 1.15 × 1011 and in the DDP, 5.93 ± 1.04 × 1011. There was a significant correlation between the pre-donation platelet count and platelet yield. The total of platelets processed for the SDP were 5.42 ± 1.08 × 1011 and for the DDP, 7.94 ± 0.77 × 1011. The collection efficiency was 71.93 ± 25.14% in the SDP and 72.94 ± 16.28% in the DDP, while the collection rates were 0.78 × 1011 and 0.94 × 1011 per minute, respectively. The average recruitment factor observed was 0.98 in the SDP, while it was 0.99 in the DDP. The mean platelet loss observed in the SDP was 35.55 ± 8.53% and in the DDP, 37.76 ± 8.65%. Conclusion The double-dose plateletpheresis supplements the platelet inventory in developing countries where the apheresis donor pool is limited. It is prudent to ensure stringent donor selection criteria for donors donating high-yield platelet products, thus enhancing donor safety and retention.

Growth-of-shgs-and-empowerment-of-women

Micro finance through Self Help Group (SHG) has been recognized internationally as the modern tool to combat poverty and for rural development. Micro finance and SHGs are effective in reducing poverty, empowering women and creating awareness which finally results in sustainable development of the nation. Micro finance define as efforts to improve poor people's access to loans and saving services may be the fastest growing and most widely recognized anti-poverty too. Micro finance includes basic financial services including small loans, savings accounts, funds transfers and insurance. A long side non-financial service such as business training Micro finance assists people living in poverty who wouldn't usually qualify for regular banking services because they have no form of collateral or formal identification. An attempt is made here to examine the impact of the microfinance on the development of the Self-Help Groups in India. The total number of self-help groups which have maintained savings with banks is 100 lakhs during 2018-19 but only 26.98 lakhs i.e 26.95 percent of the SHGs have obtained credit from the financial institutions. Out of 74.62 lakh SHGs, only 11.96 lakhs i.e. 16.03 percent of the SHGs have got micro-credit from the institutional credit agencies during 2010-11. The above analysis indicates that the number of SHGs which got micro credit has increased from 16 percent to 27 percent i.e only 11 percentage points increased in 2018-19 over 2010-11. About 73 percent of the SHGs are out of the purview of the public financial institutions. Majority of the women members of SHGs are away from the institutional credit agencies. These marginalized women have to depend on informal financial services for their credit needs. So that the financial informal sector (mostly moneylenders)has continued to rule in the rural economy. There is a need to break the monopoly of door step availability of credit to these marginalized sections by the informal sources of credit. The credit needs of the women members have enormously increasing for the last two decades. The average loan disbursement per SHG has increased from Rs.1.22 lakhs during 2010-11 to Rs.2.16 lakhs during 2018-19. This is inadequate to meet the credit requirements of the members in the SHGs. Hence it should be made four to five times of the micro credit per SHGs. The bank loans are not regularly paid by the members of the SHGs. Hence, the amount of loan outstanding has continuously increased since 2010-11. It is evident from the fact that the average outstanding bank loans against SHGs shows higher level. The average outstanding per SHG has increased from Rs.65, 224 during 2010-11 to Rs.171543 during 2018-19, shows two and half-fold increase. As a result of it the overall NPA rate in bank loan to SHGs is steadily increasing since 1910-11. However, the overall NPA rate in bank loan to SHG is 5.19 percent as on 31-03-2019 registering a fall of 93 basis points from the previous level of 6.12 percent. The above analysis reveals that the steady declining the rate of NPA is indicating the recovery of loans made of SHGs is improving during the last few years.

Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis

Abstract Background Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. Objectives To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. Methods Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. Results The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p< 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p= 0.49). Conclusion Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.

Association between enhanced recovery after surgery protocol compliance and clinical complications: a cohort study

Abstract Background Enhanced Recovery After Surgery (ERAS) protocol is composed by evidence-based interventions that aim to improve recovery through a reduction in surgical stress response. Although ERAS protocols have been introduced across the globe, exhaustive implementation is not as common. We aimed to study the ERAS protocol compliance in colorectal surgery, assessing the relationship between compliance and postoperative complications. Methods A single-center cohort study was conducted. All consecutive patients admitted to elective colorectal surgery were included. We assessed study endpoints according to ERAS protocol perioperative compliance score above 75%. Our primary endpoint was a composite of postoperative events, which includes in-hospital postoperative complications and need for reoperation after 30 days and need for readmission after discharge. Secondary endpoints were surgery-to-discharge time, postoperative use of only non-opioid adjuvants and the individual components of the primary endpoint. Results A total of 224 colorectal patients were included. The primary endpoint occurred in 59.2% (n = 58) of non-compliant patients comparing to 34.1% (n = 43) in compliant patients. In univariate analysis, compliance to ERAS protocol had an inferior risk for the primary endpoint (p< 0.001). In a logistic regression model, compliance was independently associated with a reduced risk for the primary endpoint with a odds-ratio of 0.42 (95% CI 0.23-0.75, p= 0.004). Conclusion Compliance with the ERAS protocol is associated with less complications, a reduced surgery-to-discharge time and use of only non-opioid adjuvants in the postoperative period. More studies are needed to target the most appropriate compliance goal.

Implementation of an ERAS program in patients undergoing thoracic surgery at a third-level university hospital: an ambispective cohort study

Abstract Objective To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital. Methods Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence. Results In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p = 0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p = 0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI] = 0.02 [0.00, 0.59], p = 0.03) and length of stay (HR [95% CI] = 18.5 [4.39, 78.4], p < 0.001). Conclusions The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER. 2 study

Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Compliance with Enhanced Recovery After Surgery (ERAS) protocol recommendations for bariatric surgery in an obesity treatment center

Abstract Introduction The higher risk of perioperative complications associated with obesity has made anesthesiologists increasingly concerned with the management of obese patients. Measures that improve bariatric surgery patient safety have become essential. The implementation of ERAS protocols in several surgical specialties has made it possible to achieve appropriate outcomes as to surgery safety. The aim of this study was to evaluate patient compliance with the recommendations of an ERAS protocol for Bariatric Surgery (ERABS) at a hospital specialized in obesity treatment. Methods Cross-sectional study, using a medical record database, in a hospital certified as an International Center of Excellence in Bariatric and Metabolic Surgery. The definition of the variables to be assessed was based on the most recent ERABS proposed by Thorell et al. Results were analyzed using descriptive epidemiology. Results The study evaluated all patients undergoing bariatric surgery in 2019. Mean compliance with the recommendations per participant was 42.8%, with a maximum of 55.5%, and was distributed as follows: 22.6% of compliance with preoperative recommendations, 60% to intraoperative recommendations, and 58.1% to postoperative recommendations. The anesthesiologist is the professional who provides most measures for the perioperative optimization of bariatric surgery patients. In our study we found that anesthesiologists complied with only 39.5% of ERABS recommendations. Conclusions Mean compliance with ERABS recommendations per participant was 42.8%. Considering that the study was carried out at a hospital certified as an international center of excellence, the need for introducing improvements in the care of patients to be submitted to bariatric surgery is evident.

Effect of perioperative clinical application of enhanced recovery after surgery on elderly recipients undergoing liver transplantation / 器官移植

Objective To evaluate the application value of perioperative interventional strategy guided by enhanced recovery after surgery (ERAS) in elderly recipients undergoing liver transplantation. Methods Clinical data of 405 liver transplant recipients were retrospectively analyzed. According to age, all recipients were divided into the elderly (≥60 years, n=122) and non-elderly groups (< 60 years, n=283). All patients received perioperative interventions under the guidance of ERAS. Intraoperative and postoperative indexes, incidence of postoperative complications and discharge were analyzed between two groups. Results There were no significant differences in the duration of anesthesia, operation time, anhepatic phase, hemorrhage volume, blood transfusion volume, lactic acid level before abdominal closure, ventilator-assisted time, the length of intensive care unit (ICU) stay, Caprini score, CHIPPS score, time of gastric tube, urinary tube and drainage tube removal, time to first drinking, time to first physical activity and time to first flatus between two groups (all P > 0.05). In the elderly group, the time to first feeding was later than that in the non-elderly group (P < 0.05). There were no significant differences in the incidence of fever, ascites, pulmonary infection, delayed gastric emptying, hemorrhage and inactive venous thrombosis between two groups (all P > 0.05). No significant differences were observed in the levels of aspartate aminotransferase, total bilirubin, direct bilirubin, serum creatinine before discharge and total length of hospital stay between two groups (all P > 0.05). The alanine aminotransferase level in elderly recipients was lower than that in non-elderly counterparts, and the difference was statistically significant (P < 0.05). No unplanned reoperation was performed within postoperative 30 d in two groups. There was no significant difference in the re-hospitalization rate within 30 d after discharge (P > 0.05). Conclusions ERAS-guided interventional strategy contributes to perioperative recovery of elderly recipients undergoing liver transplantation, and yields equivalent postoperative recovery between elderly and non-elderly recipients.

Effects of sports training associated with nutritional intervention on athletes' post-competition recovery / Efeitos do treinamento esportivo associado à intervenção nutricional sobre a recuperação dos atletas pós-competição / Efectos del entrenamiento deportivo asociado a una intervención nutricional en la recuperación post competición de los deportistas

ABSTRACT Introduction: The athletes' physiological capacity and psychological level are raised to the limit during the competition, which is necessary for adequate recovery after the dispute. Objective: Study the effect of sports training associated with nutritional intervention on athletes' post-competition recovery. Methods: In the first two weeks of the experiment, training was done in slow aerobic exercise, aerobics, and running. Strength training and a small amount of anaerobic training were added to the training with the gradual practice of the experiment. Results: The proportion of breakfast, lunch, and dinner was 25.33%, 42.55%, and 32.12%, respectively; protein intake decreased from 34.23% to 20.13%, and the proportion of fat intake decreased from 15. 56% to 12.3%, and IgG content changed from 7.654 ± 0.283 (mmol/L) at the end to 8.586 ± 0.651 (mmol/L); IgM content changed from 3.382 ± 0.875 (g/L) at the end to 3.169 ± 1.002 (g/L). Conclusion: Athletes can effectively, through sports training and nutritional intervention, adjust body changes caused by competition while maintaining a good exercise level. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A capacidade fisiológica e o nível psicológico dos atletas são elevados ao limite durante a competição, sendo necessária uma recuperação adequada após a disputa. Objetivo: Estudar o efeito do treinamento esportivo associado à intervenção nutricional para a recuperação dos atletas após a competição. Métodos: Nas duas primeiras semanas da experiência, realizou-se o treinamento na forma de exercício aeróbico lento, aeróbica e corrida. O treinamento de força e uma pequena quantidade de treinamento anaeróbico foram adicionados ao treinamento com a prática gradual do experimento. Resultados: A proporção de café da manhã, almoço e jantar foi de 25,33%, 42,55% e 32,12% respectivamente, a proporção de ingestão de proteínas diminuiu de 34,23% para 20,13%, a proporção de ingestão de gordura diminuiu de 15,56% para 12,3%, e o conteúdo de IgG mudou de 7,654 ± 0,283 (mmol/L) no final para 8,586 ± 0,651 (mmol/L); o conteúdo de IgM mudou de 3,382 ± 0,875 (g/L) no final para 3,169 ± 1,002 (g/L). Conclusão: Os atletas podem de maneira eficaz, através de treinamento esportivo e intervenção nutricional, ajustar as alterações corporais ocasionadas pela competição, mantendo um bom nível de exercício. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La capacidad fisiológica y el nivel psicológico de los atletas se elevan al límite durante la competición, siendo necesaria una adecuada recuperación tras la disputa. Objetivo: Estudiar el efecto del entrenamiento deportivo asociado a la intervención nutricional para la recuperación de los deportistas tras la competición. Métodos: En las dos primeras semanas del experimento, el entrenamiento se realizó en forma de ejercicio aeróbico lento, aeróbic y carrera. El entrenamiento de fuerza y una pequeña cantidad de entrenamiento anaeróbico se añadieron al entrenamiento con la práctica gradual del experimento. Resultados: La proporción de desayuno, comida y cena fue del 25,33%, 42,55% y 32,12% respectivamente, la proporción de ingesta de proteínas descendió del 34,23% al 20,13%, la proporción de ingesta de grasas descendió del 15. 56% a 12,3%, y el contenido de IgG pasó de 7,654 ± 0,283 (mmol/L) al final a 8,586 ± 0,651 (mmol/L); el contenido de IgM pasó de 3,382 ± 0,875 (g/L) al final a 3,169 ± 1,002 (g/L). Conclusión: Los atletas pueden ajustar eficazmente, mediante el entrenamiento deportivo y la intervención nutricional, los cambios corporales provocados por la competición, manteniendo un buen nivel de ejercicio. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Fatigue and the recovery ways in athlete runners / Fadiga e suas vias de recuperação em corredores esportistas / La fatiga y sus vías de recuperación en corredores deportistas

ABSTRACT Introduction: With the continuous development of running, great changes have occurred in training media, equipment, and training concepts. Running fatigue and recovery have increasingly become the direction of research by scientists worldwide. Objective: In this paper, the mechanism, causes, and measures of biological recovery in athletes during training are discussed. Method: The effects of different interventions on athletes' recovery after training were analyzed through protocoled experiments. Effective methods of fatigue recovery were presented. The study compared the variables of the sprinter's morning heart rate, blood pressure, body temperature, CK, BUN, RPE, and other indicators to understand the recovery of middle and long-distance runners after training. Results: Recovery measures are effective when combined with exercise training based on the fatigue mechanism. Conclusion: Subjective sensory, physiological, and biochemical indicators are used to judge the intensity of fatigue in exercise training, and the fatigue recovery phase of exercise training is an important item to consider during training activities. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Com o desenvolvimento contínuo da corrida, grandes mudanças ocorreram nos meios de treinamento, nos equipamentos e conceitos de treinamento. A fadiga e a recuperação da corrida têm se tornado cada vez mais a direção da pesquisa de cientistas em todo o mundo. Objetivo: Neste artigo, são discutidos o mecanismo, as causas e suas medidas de recuperação biológica nos atletas durante o treinamento. Método: Através de experimentos protocolados, foram analisados os efeitos de diferentes intervenções sobre a recuperação dos atletas após o treinamento. Métodos eficazes de recuperação da fadiga foram apresentados. O estudo comparou as variáveis da frequência cardíaca matinal do velocista, pressão arterial, temperatura corporal, CK, BUN, RPE e outros indicadores para entender a recuperação dos corredores de média e longa distância após o treinamento. Resultados: As medidas de recuperação são efetivas quando combinadas ao treinamento de exercício baseado no mecanismo de fadiga. Conclusão: Os indicadores sensoriais subjetivos, fisiológicos e bioquímicos são usados para julgar a intensidade da fadiga no treinamento físico, sendo a fase de recuperação da fadiga do treinamento físico um item importante a ser considerado durante as atividades de treinamento. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Con el continuo desarrollo de las carreras, se han producido grandes cambios en los medios de entrenamiento, el equipamiento y los conceptos de entrenamiento. La fatiga y la recuperación en la carrera se han convertido cada vez más en objeto de investigación por parte de científicos de todo el mundo. Objetivo: En este artículo, se discute el mecanismo, las causas y las medidas de la recuperación biológica en los atletas durante el entrenamiento. Método: Mediante experimentos protocolizados, se analizaron los efectos de diferentes intervenciones en la recuperación de los atletas después del entrenamiento. Se presentaron métodos eficaces de recuperación de la fatiga. El estudio comparó las variables de la frecuencia cardíaca matutina de los velocistas, la presión arterial, la temperatura corporal, la CK, el BUN, el RPE y otros indicadores para comprender la recuperación de los corredores de media y larga distancia después del entrenamiento. Resultados: Las medidas de recuperación son eficaces cuando se combinan con el entrenamiento del ejercicio basado en el mecanismo de la fatiga. Conclusión: Los indicadores subjetivos sensoriales, fisiológicos y bioquímicos se utilizan para juzgar la intensidad de la fatiga en el entrenamiento con ejercicios, y la fase de recuperación de la fatiga del entrenamiento con ejercicios es un elemento importante que debe tenerse en cuenta durante las actividades de entrenamiento. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Fatigue and physical recovery in basketball under covid-19 / Fadiga e recuperação física no basquetebol em meio a covid-19 / Fatiga y recuperación física en baloncesto en el marco de covid-19

ABSTRACT Introduction: A new research direction to strengthen basketball, improve physical function and enhance the immunity of athletes during the epidemic situation of COVID-19 is requested. Objective: Explore the specific methods of basketball fatigue and physical recovery under the outlook of COVID-19. Methods: 36 college volunteers without significant differences in height, weight, or age were randomly selected for the research. Divided into two groups, the intervention mode of the experimental group was vibration foam roller intervention, while the control group adopted the traditional walking and stretching method. The subjective assessment data of lactic acid change and exercise fatigue were collected and analyzed. Results: One hour after exercise, the rate, and decrease of lactic acid in the experimental group were statistically higher. Before the beginning of the experiment, the subjective assessment of fatigue in the control group was (16.031 ± 2.4438) points, and that in the experimental group was (16.139 ± 2.7043) points. After the end of the ninth week, the subjective assessment of fatigue in the control group was (14.646 ± 2.7453) points, while in the experimental group, it was (11.576 ± 3.2552). Conclusion: The vibrating foam roller massage method can recover athletes from muscle fatigue more efficiently while respecting the limitations imposed by the epidemic situation. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Uma nova direção de pesquisa para fortalecer o basquetebol, melhorar o nível da função física e aumentar a imunidade dos atletas sob a situação epidêmica da COVID-19 é requisitada. Objetivo: Explorar os métodos específicos de fadiga do basquetebol e recuperação física sob o panorama da COVID-19. Métodos: Foram selecionados aleatoriamente 36 universitários voluntários sem diferenças significativas de altura, peso ou idade para a pesquisa. Divididos em dois grupos, o modo de intervenção do grupo experimental foi a intervenção com rolo de espuma vibratória, enquanto o grupo de controle adotou o método tradicional de caminhada e alongamento. Os dados da avaliação subjetiva da mudança do ácido lático e da fadiga do exercício foram coletados e analisados. Resultados: Em uma hora após o exercício, a taxa e a diminuição do ácido láctico no grupo experimental foram estatisticamente superiores. Antes do início do experimento, a avaliação subjetiva da fadiga no grupo controle foi de (16.031 ± 2.4438) pontos, e a do grupo experimental foi de (16.139 ± 2.7043) pontos. Após o final da nona semana, a avaliação subjetiva da fadiga no grupo controle foi de (14.646 ± 2.7453) pontos, enquanto no experimental foi de (11.576 ± 3.2552) pontos. Conclusão: O método de massagem por rolo de espuma vibratória pode recuperar os atletas da fadiga muscular de forma mais eficiente, respeitando as limitações impostas pela situação epidêmica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Se solicita una nueva dirección de investigación para fortalecer el baloncesto, mejorar el nivel de la función física y aumentar la inmunidad de los atletas bajo la situación epidémica de COVID-19. Objetivo: Explorar los métodos específicos de fatiga y recuperación física en baloncesto bajo la perspectiva de COVID-19. Métodos: Para la investigación se seleccionaron aleatoriamente 36 estudiantes universitarios voluntarios sin diferencias significativas de estatura, peso o edad. Divididos en dos grupos, el modo de intervención del grupo experimental fue la intervención con rodillo de espuma vibratoria, mientras que el grupo de control adoptó el método tradicional de caminar y estirar. Se recogieron y analizaron los datos de la evaluación subjetiva del cambio del ácido láctico y la fatiga del ejercicio. Resultados: Una hora después del ejercicio, la tasa y la disminución de ácido láctico en el grupo experimental fueron estadísticamente superiores. Antes del inicio del experimento, la evaluación subjetiva de la fatiga en el grupo de control fue de (16,031 ± 2,4438) puntos, y la del grupo experimental fue de (16,139 ± 2,7043) puntos. Al final de la novena semana, la evaluación subjetiva de la fatiga en el grupo de control fue de (14,646 ± 2,7453) puntos, mientras que en el grupo experimental fue de (11,576 ± 3,2552) puntos. Conclusión: El método de masaje con rodillo de espuma vibratorio puede recuperar a los deportistas de la fatiga muscular de forma más eficaz, respetando las limitaciones impuestas por la situación epidémica. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Protocolo de recuperación intensificada durante la cirugía del plexo braquial (RIPLEX)

La restauración de la función del miembro superior en los pacientes que sufren lesiones del plexo braquial para favorecer la mejoría en su calidad de vida. Así como su reinserción social y laboral, se puede optimizar mediante la implementación de programas de recuperación intensificada o mejorada, multimodales, multidisciplinarios, y de elevados estándares cualitativos, denominados protocolos ERAS (Enhanced Recovery After Surgery), se recomienda la utilización de métodos fundamentados en la mejor evidencia científica disponible. El protocolo que se expone, aplicado en el Complejo Científico Ortopédico Internacional "Frank Paísˮ, derivado de una investigación institucional en curso. Objetivos: Contribuir en el desarrollo del conocimiento científico imprescindible para favorecer la introducción y sistematización de los cuidados perioperatorios multimodales durante las intervenciones quirúrgicas del plexo braquial.

Introduction: Restoration of upper limb function in patients suffering from brachial plexus injuries, in view of favoring improvement in their quality of life or their social and labor reinsertion, can be optimized by means of implementing multimodal, multidisciplinary, intensified or enhanced recovery programs with high qualitative standards, called ERAS (enhanced recovery after surgery) protocols. The use of methods based on the best available scientific evidence is recommended. The protocol presented here is applied at Complejo Científico Ortopédico Internacional "Frank Paísˮ and derived from an ongoing institutional research. Objective: To contribute to the development of scientific knowledge essential to favor the introduction and systematization of multimodal perioperative care during brachial plexus surgical interventions.

Chewing insects, pollinators, and predators on Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) plants fertilized with dehydrated sewage sludge / Insetos mastigadores, polinizadores e predadores em plantas de Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) fertilizada com lodo de esgoto desidratado

Fertilization with dehydrated sewage sludge can speed up the recovery process of degraded areas due to nutrients concentration, favoring the development of pioneer plants such as Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) and the emergence of insects. This study aimed the evaluation of chewing, pollinating insects, predators, their ecological indices and relationships on A. auriculiformis plants fertilized with dehydrated sewage sludge. The experimental design was completely randomized with two treatments (with and without dehydrated sewage sludge) and 24 repetitions. The prevalence of chewing insects Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae), and Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), defoliation, and ecological indices of abundance of Coleoptera and Orthoptera were observed on fertilized A. auriculiformis. Acacia auriculiformis plants, with a superior number of branches/tree, revealed greater abundance of Coleoptera and Orthoptera, species richness of pollinating insects, defoliation, numbers of Parasyphraea sp. and T. collaris. The ones with larger leaves/branches displayed greater abundance of species richness of Coleoptera and Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Therefore, the use of A. auriculiformis plants, fertilized with dehydrated sewage sludge, is promising in the recovery of degraded areas due to the ecological indices increase of chewing and pollinators insects and spiders in the analyzed area.

A fertilização com lodo de esgoto desidratado pode acelerar o processo de recuperação de áreas degradadas devido à concentração de nutrientes, favorecendo o desenvolvimento de plantas pioneiras tais como Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) e de seus insetos. O objetivo deste trabalho foi avaliar os insetos mastigadores, polinizadores e predadores e seus índices e relações ecológicas em plantas de A. auriculiformis fertilizadas com lodo de esgoto desidratado, em área degradada, durante 24 meses. O delineamento foi inteiramente casualizados com dois tratamentos (com e sem adubação com lodo de esgoto desidratado) e 24 repetições (uma repetição = uma planta). O maior número de insetos mastigadores Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae) e Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), de desfolha, e do índice ecológico abundância de Coleoptera e de Orthoptera foram maiores em plantas de A. auriculiformis fertilizadas do que nas não fertilizadas com lodo de esgoto desidratado. Plantas de A. auriculiformis, com maior quantidade de galhos/árvore, apresentaram maiores abundâncias de Coleoptera e Orthoptera, riqueza de espécies de insetos polinizadores, desfolha e números de Parasyphraea sp. e T. collaris, e as com maior folhas/galho os de riqueza de espécies de Coleoptera e Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Por tanto, a utilização de A. auriculiformis, adubada com lodo de esgoto desidratado, é promissora na recuperação de áreas degradadas devido ao aumento dos índices ecológicos de insetos mastigadores, polinizadores e aranhas na área.

Gender-based incidence, recovery period, and mortality rate of COVID-19 among the population of district Attock, Pakistan / Incidência baseada em gênero, período de recuperação e taxa de mortalidade de COVID-19 entre a população do distrito de Attock, Paquistão

COVID-19 is reported as an extremely contagious disease with common symptoms of fever, dry cough, sore throat, and tiredness. The published literature on incidence and gender-wise prevalence of COVID-19 is scarce in Pakistan. Therefore, the present study was designed to compare the distribution, incubation period and mortality rate of COVID-19 among the male and female population of district Attock. The data were collected between 01 April 2020 and 07 December 2020 from the population of district Attock, Pakistan. A total of 22,962 individuals were screened and 843 were found positive for RT-qPCR for SARS-CoV-2. The confirmed positive cases were monitored carefully. Among the positive cases, the incidence of COVID-19 was 61.7% among males and 38.2% among females. The average recovery period of males was 18.89±7.75 days and females were 19±8.40 days from SARS-CoV-2. The overall mortality rate was 8.06%. The death rate of male patients was significantly higher (P<0.05) compared to female patients. Also, the mortality rate was higher (P<0.05) in male patients of 40-60 years of age compared to female patients of the same age group. Moreover, the mortality rate significantly increased (P<0.05) with the increase of age irrespective of gender. In conclusion, the incidence and mortality rate of COVID-19 is higher in males compared to the female population. Moreover, irrespective of gender the mortality rate was significantly lower among patients aged <40 years.

Covid-19 é relatada como uma doença extremamente contagiosa com sintomas comuns de febre, tosse seca, dor de garganta e cansaço. A literatura publicada sobre incidência e prevalência de Covid-19 com base no gênero é escassa no Paquistão. Portanto, o presente estudo teve como objetivo comparar a distribuição, o período de incubação e a taxa de mortalidade de Covid-19 entre a população masculina e feminina do distrito de Attock. Os dados foram coletados entre 1 de abril de 2020 e 7 de dezembro de 2020 da população do distrito de Attock, Paquistão. Um total de 22.962 indivíduos foi selecionado, e 843 foram considerados positivos para RT-qPCR para SARS-CoV-2. Os casos positivos confirmados foram monitorados cuidadosamente. Entre os casos positivos, a incidência de Covid-19 foi de 61,7% no sexo masculino e 38,2% no feminino. O período médio de recuperação dos homens foi de 18,89 ± 7,75 dias e das mulheres 19 ± 8,40 dias do SARS-CoV-2. A mortalidade geral foi de 8,06%. A taxa de mortalidade de pacientes do sexo masculino foi significativamente maior (P < 0,05) em comparação com pacientes do sexo feminino. Além disso, a taxa de mortalidade foi maior (P < 0,05) em pacientes do sexo masculino com 40-60 anos de idade em comparação com pacientes do sexo feminino da mesma faixa etária. Além disso, a taxa de mortalidade aumentou significativamente (P < 0,05) com o aumento da idade, independentemente do sexo. Em conclusão, a incidência e a taxa de mortalidade de Covid-19 são maiores no sexo masculino em comparação com a população feminina. E também, independentemente do sexo, a taxa de mortalidade foi significativamente menor entre os pacientes com idade < 40 anos.