Critical speed, thresholds for vo2max and boundaries of the severe exercise intensity domain / Velocidad crítica, vo2máx y límites de el dominio de la intensidad del ejercicio severo / Velocidade crítica, vo2max e limites de o domínio de intensidade de exercício severo

ABSTRACT Introduction: The severe exercise intensity domain can be defined as the range of work rates or speeds over which VO2max can be elicited. Objectives: Our purpose was to determine if critical speed (running analog of critical power) identifies the lower boundary of the severe domain and to identify the upper boundary of the domain. Methods: Twenty-five individuals performed five running tests to exhaustion, each lasting > 2.5 min and < 16 min. The two-parameter speed vs time-to-exhaustion relationship generated values for critical speed and the three-parameter speed vs time-to-reach-VO2max relationship generated values for the threshold speed above which VO2max can be elicited. The relationships were solved to calculate the minimum time needed to elicit VO2max. Results: Critical speed (3.00 ± 0.38 m·s−1) and the threshold speed above which VO2max can be elicited (2.99 ± 0.37 m·s−1) were correlated (r = 0.83, p < 0.01) and did not differ (p = 0.70), confirming critical speed as the lower boundary of the severe domain. The minimum time needed to elicit VO2max (103 ± 7 s) and the associated highest speed at which VO2max can be elicited (4.98 ± 0.52 m·s−1) identified the upper boundary of the severe domain for these participants. Conclusion: The critical power concept, which requires no metabolic measurements, can be used to identify the lowest speed at which VO2max can be elicited. With addition of metabolic measurements, mathematical modeling can also identify the highest speed and shortest exercise duration at which VO2max can be elicited. Evidence Level I; Validating cohort study with good reference standards.

RESUMEN Introducción: El dominio de la intensidad del ejercicio severo se puede definir como el rango de ritmos o velocidades de trabajo sobre las que se puede obtener el VO2max. Objetivos: Nuestro propósito fue determinar si la velocidad crítica (funcionamiento analógico de potencia crítica) identifica el límite inferior del dominio severo e identificar el límite superior del dominio. Métodos: Veinticinco personas realizaron cinco pruebas de carrera hasta el agotamiento, cada una con una duración de > 2,5 min y <16 min. La relación de dos parámetros de velocidad frente a tiempo de agotamiento generó valores para la velocidad crítica y la relación de tres parámetros de velocidad frente a tiempo de alcance de VO2max generó valores para la velocidad umbral por encima del cual se puede obtener el VO2max. Las relaciones se resolvieron para calcular el tiempo mínimo necesario para obtener el VO2max. Resultados: La velocidad crítica (3,00 ± 0,38 m·s−1) y la velocidad umbral por encima de la cual se puede obtener el VO2max (2,99 ± 0,37 m·s−1) se correlacionaron (r = 0,83, p < 0,01) y no difirieron (p = 0,70), lo que confirma la velocidad crítica como el límite inferior del dominio severo. El tiempo mínimo necesario para obtener el VO2max (103 ± 7 s) y la velocidad más alta asociada a la que se puede obtener el VO2max (4,98 ± 0,52 m·s−1) identificaron el límite superior del dominio severo para estos participantes. Conclusión: El concepto de potencia crítica, que no requiere mediciones metabólicas, se puede utilizar para identificar la velocidad más baja a la que se puede obtener el VO2max. Con la adición de mediciones metabólicas, el modelado matemático también puede identificar la velocidad más alta y la duración más corta del ejercicio a la que se puede obtener VO2max. Nivel de Evidencia I; Estudio de cohortes con alto estándar de referencia.

RESUMO Introdução: O domínio de intensidade de exercício severo pode ser definido como a faixa de taxas de trabalho ou velocidades sobre as quais o VO2max pode ser obtido. Objetivos: Nosso propósito foi determinar se a velocidade crítica (execução analógica da potência crítica) identifica o limite inferior do domínio severo e identificar o limite superior do domínio. Métodos: Vinte e cinco indivíduos realizaram cinco testes de corrida até a exaustão, cada um com duração > 2,5 min e < 16 min. A relação velocidade de dois parâmetros contra tempo até a exaustão gerou valores para a velocidade crítica e a relação velocidade de três parâmetros contra tempo para alcançar o VO2max valores gerados para a velocidade limite acima da qual o VO2max pode ser obtido. As relações foram resolvidas para calcular o tempo mínimo necessário para eliciar o VO2max. Resultados: A velocidade crítica (3,00 ± 0,38 m·s−1) e a velocidade limite acima da qual o VO2max pode ser eliciado (2,99 ± 0,37 m·s−1) foram correlacionadas (r = 0,83, p < 0,01) e não diferiram (p = 0,70), confirmando a velocidade crítica como o limite inferior do domínio grave. O tempo mínimo necessário para eliciar o VO2max (103 ± 7 s) e a maior velocidade associada na qual o VO2max pode ser eliciado (4,98 ± 0,52 m·s−1) identificou o limite superior do domínio severo para esses participantes. Conclusão: O conceito de potência crítica, que não requer medidas metabólicas, pode ser usado para identificar a velocidade mais baixa em que o VO2max pode ser eliciado. Com a adição de medidas metabólicas, a modelagem matemática também pode identificar a velocidade mais alta e a duração mais curta do exercício em que o VO2max pode ser obtido. Nível de Evidência I; Estudo de coorte com alto padrão de referência.

Impacto del Entrenamiento Respiratorio de Hiperpnea Isocápnica Voluntaria sobre el Costo Energético asociado a la Respiración inducido por Ejercicio Físico / Impact of Voluntary Isocapnic Hyperpnea training on the cost of breathing

Introducción. Determinar el efecto de ocho semanas de entrenamiento por hiperpnea isocápnica voluntaria (HIV) sobre el costo energético asociado a la respiración (COB) reflejado en los cambios en la oxigenación de los músculos intercostales (∆SmO2-m. intercostales) inducida por ejercicio físico de intensidad incremental. Métodos. Doce participantes físicamente activos fueron entrenados durante ocho semanas de HIV 3 días x semana, 12 minutos, al 60% de ventilación voluntaria máxima (VVM). En la semana previa y posterior al entrenamiento HIV se realizó un test cardiopulmonar (CPET) de intensidad incremental en cicloergómetro, durante esta prueba se registró la ∆SmO2-m. intercostales mediante el dispositivo MOXY®. El efecto de HIV sobre la ∆SmO2-m. intercostales se analizó mediante la prueba two-way mixed ANOVA considerando los factores (fase × tarea). Resultados. ∆SmO2-m.intercostales fue significativamente menor a partir del 30% (­5,0±4,7%; p<0.01) hasta el 100% (­10,6±12,8%; p<0.01) de la tarea luego de ocho semanas de HIV. Además, se reportó un aumento de la presión inspiratoria máxima (PIM)=16,5±11,4 cmH2O (p<0.01); y de la resistencia muscular respiratoria=106,6±149,0 s (p<0.01). El tiempo total de ejercicio aumentó en 106,6±149,0 s (p=0.04), así como la carga total en 10,50± 10,12 vatios (p<0.01). Conclusión. El HIV disminuye el COB inducido por ejercicio incremental asociado a un incremento en la performance física y de los músculos respiratorios. En futuros estudios se sugiere estudiar esta estrategia de entrenamiento analítico de los músculos respiratorios en usuarios con limitación física relacionada al aumento prematuro del COB.

Background. Objetive. To determine the effect of eight weeks of voluntary isocapnic hyperpnea (VIH) training on cost of breathing (COB) as reflected by intercostales muscles deoxygenation (∆SmO2-m. intercostales) induced by incremental-intensity physical exercise. Methods. Twelve physically active participants underwent eight weeks of VIH training, three days a week, for 12 minutes each session, at 60% of maximal voluntary ventilation (MVV). In the week before and after VIH training, a cardiopulmonary test (CPET) of incremental intensity was performed on a cycloergometer. During this test, intercostal ∆SmO2-m.intercostales was recorded using the MOXY® device. The effect of VIH on ∆SmO2-m.intercostales were analyzed using a two-way mixed ANOVA test considering the factors (phase × task). Results. ∆SmO2-m.intercostales significantly decreased from 30% (­5.0±4.7%; p<0.01) to 100% (­10.6±12.8%; p<0.01) of the task after eight weeks of VIH. Additionally, an increase in maximal inspiratory pressure (MIP) of 16.5±11.4 cmH2O (p<0.01) and respiratory muscle endurance of 106.6±149.0 s (p<0.01) was reported. Total exercise time increased by 106.6±149.0 s (p=0.04), as well as total workload by 10.50±10.12 watts (p<0.01). Conclusion. VIH reduces COB induced by incremental exercise and is associated with increased physical and respiratory muscle performance. Future studies should explore this respiratory muscle training strategy for individuals with physical limitations related to a premature increase in COB.

COMPARATIVE ANALYSIS OF HAEMATOLOGICAL PARAMETERS AMONG INFREQUENT AND REGULAR REPEAT WHOLE BLOOD DONORS IN A TERTIARY CARE CENTRE-A PILOT STUDY

Blood transfusion service is a vital part of our health care system. Stringent blood donor screening and medical examination plays a vital role in maintaining the quality and safety of blood components. Voluntary non-remunerated blood donors form the backbone of blood transfusion services. However, regular donation by such voluntary donors may cause significant depletion of iron stores in the body. This has the potential to adversely affect the donor's health, and also to lower the quality of blood being collected subsequently. Even though a pre-donation hemoglobin estimation is routinely done in blood centres, it may fail to recognize subclinical iron store depletion. Testing Ferritin level of all donors is not cost effective and practical in resource limited centres. This study was aimed to identify any significant changes in hematological parameters over repeated blood donations, that may point towards a potential Iron deficiency in an otherwise healthy donor. This was a cross sectional study involving 138 whole blood donors who had attended the blood centre, Department of Transfusion Medicine, Government Medical college, Thiruvananthapuram. The study subjects were categorized into 2 groups based on the number of donations and a Complete blood count (CBC) was done for each group. Data was analyzed using SPSS software, quantitative variables expressed as Mean and Standard Deviation, p value <0.05 was considered statistically significant. Results were analysed by Independent Samples T test. Statistically significant variables were further analysed using Kruskal-Wallis test. Second time blood donors constituted major part of sample size (20/138). Mean Hemoglobin value showed no significant change among the two donor categories. Mean corpuscular volume (MCV) of repeat whole blood donors is significantly lower than infrequent donors independent samples T test, tvalue=3.309. (p-value=0.001). Donors were further subdivided into 5 groups in the order of increasing number of donations and significant difference was observed in MCV and proved by Kruskal-Wallis test(H=19.1344) As per our study, a significant reduction in MCV among repeat donors with a normal hemoglobin value compared to infrequent donors. This might point towards an impending Iron deficiency anemia in near future. A prompt detection of subclinical iron deficiency in voluntary blood donors is the need of the hour since it can cause adverse consequences in donor health and can considerably lower the donor availability as well. Blood centres should take measures like routine Iron stores evaluation of regular repeat donors, educating donors regarding the importance of maintaing a healthy diet, Iron tablet supplementation to prevent donor Iron deficiency anemia (IDA) etc.

La sed ¿un mecanismo suficiente para lograr euhidratación?: una revisión narrativa / Is thirst sufficient as a mechanism for achieving euhydration? a narrative review

Capitán, C. y Aragón, L.F. (2023). La sed ¿un mecanismo suficiente para lograr euhidratación?: una revisión narrativa. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. El papel de la percepción de sed para mantener el balance hídrico ha sido ampliamente estudiado, tanto durante el ejercicio como después de este. Sin embargo, la forma de evaluarla y la eficacia de los instrumentos existentes son aún áreas que necesitan más investigación. El objetivo de esta revisión fue integrar, de forma general, la información disponible en la literatura sobre el funcionamiento del mecanismo de la sed como respuesta a la deshidratación durante y después del ejercicio. Se explican los mecanismos fisiológicos y las respuestas de estos durante y posterior al ejercicio; además, se describen los instrumentos disponibles en la literatura científica, sus debilidades y fortalezas, y se plantea una serie de preguntas que aún no tienen respuesta en el área. En esta revisión se presenta el aspecto teórico de los mecanismos de la sed, además, se discuten los estudios científicos que respaldan o refutan el comportamiento de estos mecanismos en el ejercicio. Finalmente, se hace un resumen de las principales conclusiones extraídas de la literatura científica sobre la sed como un mecanismo suficiente para prevenir la deshidratación tanto durante como después del ejercicio.

Capitán, C. y Aragón, L.F. (2023). Is thirst sufficient as a mechanism for achieving euhydration? a narrative review. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. The role of thirst perception for keeping hydric balance, both during and after exercise, has been extensively studied. However, the way to assess it and the effectiveness of the existing instruments are areas that still require further research. The objective of this review is to integrate, in a general way, the information available in the literature on the functioning of the thirst mechanism as a response to dehydration during and after exercise. The physiological mechanisms and their responses during and after exercise are explained. In addition, a description of the instruments available in scientific literature is included, together with their weaknesses and strengths, and a series of as yet unanswered questions in this area are raised. This review presents the theoretical aspect of thirst mechanisms, and discusses the scientific studies that support or refute the behavior of these mechanisms in exercise. Finally, a summary is made of the major conclusions drawn from the scientific literature on thirst as a sufficient mechanism to prevent dehydration both during and after exercise.

Capitán, C. y Aragón, L.F. (2023). A sede é um mecanismo suficiente para alcançar a hidratação? uma revisão narrativa. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. O papel da percepção da sede na manutenção do equilíbrio hídrico tem sido amplamente estudado, tanto durante quanto após o exercício. Entretanto, como avaliá-la e a eficácia dos instrumentos existentes ainda são áreas que necessitam de mais pesquisas. Esta revisão visou integrar, de forma geral, as informações disponíveis na literatura sobre o funcionamento do mecanismo da sede em resposta à desidratação durante e após o exercício. Ele explica os mecanismos fisiológicos e suas respostas durante e após o exercício, descreve os instrumentos disponíveis na literatura científica, seus pontos fracos e fortes, e levanta uma série de questões que permanecem sem resposta no campo. Esta revisão apresenta o aspecto teórico dos mecanismos da sede e discute os estudos científicos que respaldam ou refutam o comportamento desses mecanismos no exercício. Finalmente, é feito um resumo das principais conclusões extraídas da literatura científica sobre a sede como mecanismo suficiente para prevenir a desidratação tanto durante quanto após o exercício.

Euthanasia Attitudes Questionnaire in Medical Personnel (AHE-PM) / Cuestionario de actitudes hacia la eutanasia en personal médico (AHE-PM)

Abstract The right to die is an international dilemma. Some countries and states already have laws regulating one of the most common applications of this right, the active voluntary euthanasia. The evidence from these countries highlights the importance of a bioethical framework to limit some of its applications. In this regard, the evaluation of attitudes towards euthanasia in medical personnel will allow to understand the attitudes of these professionals and how they can deal with such requests, whether this assisted death is decided by the patients or their surroundings. Consequently, the aim of this study was to develop a brief scale to evaluate attitudes, as well as to determine their significance according to the gender and seniority of the professionals in this situation. A double design strategy was followed. On the one hand, a psychometric design with an exploratory and confirmatory factor analysis and, on the other, a descriptive analytical design for the comparison of groups. A six-item scale (AE-PM) and two factors were extracted. The first focuses on attitudes towards euthanasia to alleviate suffering for medical reasons and the second one to alleviate the patient's emotional suffering. The scale (AHE-PM) is useful for the rapid exploration of attitudes towards euthanasia in physicians, a professional group with limited free time, who may also encounter relatively frequent requests for active voluntary euthanasia. The two factors obtained allow attitudes to be assessed from a bioethical perspective, providing information on the application under apparent medical justification and in situations based on the patient's subjective emotional suffering.

Resumen La eutanasia voluntaria activa se define como la petición de un paciente que quiere morir y la acción que es llevada a cabo por otra persona para provocar dicha muerte. El derecho a morir es un dilema sobre el que se debate a nivel internacional. Algunos países y estados ya cuentan con leyes que regulan una de las aplicaciones más comunes de este derecho. Los datos aportados por estos países ponen de manifiesto la importancia de un marco bioético que permita limitar algunas de sus aplicaciones. En este sentido, la evaluación de las actitudes hacia la eutanasia en personal médico permitirá conocer las actitudes de estos profesionales y cómo estos pueden enfrentarse a dichas solicitudes, o no, sea de muerte asistida por parte de los pacientes o su entorno. Además, se ha reportado en la bibliografía diferentes actitudes según la experiencia o el sexo de los trabajadores, por lo que es de relevancia su exploración diferencial. Por ello, el objetivo del presente trabajo un instrumento de evaluación de actitudes hacia la eutanasia diseñado y validado por y para profesionales médicos en ejercicio. En esta línea, los objetivos de este estudio son obtener una escala corta con propiedades psicométricas adecuadas, que proporcione información relevante sobre las actitudes hacia la eutanasia, así como la posible evaluación de algunas prácticas médicas relacionadas con ésta que pueden ser bioéticamente dudosas. La muestra estaba compuesta por 419 profesionales de la medicina procedentes de tres provincias del sur de España. Se siguió una doble estrategia en el diseño. Por un lado, un diseño psicométrico con un análisis factorial exploratorio y confirmatorio. Se dividió la muestra en dos submuestras aleatorias para realizar de forma paralela ambos análisis. Se utilizaron los estadísticos KMO, Bartlett, RMSEA, RMRS, CFI, NNFI, GFI y AGFI para explorar el ajuste de modelos. Po otro lado, se utilizó un diseño asociativo descriptivo para la comparación de grupos mediante la t de Student, ANOVA, Tukey y la prueba d de Cohen. Se extrae una escala de seis ítems (AE-PM) y dos factores. El primero de ellos está centrado en las actitudes hacia la eutanasia para aliviar el sufrimiento por cuestiones médicas y el segundo para aliviar el sufrimiento emocional del paciente. Respecto al estudio de las diferencias, no se observaron diferencias significativas según el sexo del profesional ni la antigüedad en la profesión. La escala (AHE-PM) es útil para la exploración rápida de las actitudes hacia la eutanasia en médicos, un grupo profesional con limitado tiempo libre que, además, puede encontrarse con relativa frecuencia ante solicitudes de eutanasia voluntaria activa. Los dos factores obtenidos permiten evaluar, por un lado, las actitudes desde una perspectiva bioética. Es de especial relevancia en estas situaciones el conocimiento de las actitudes del personal médico hacia la eutanasia, exponiéndolo a un dilema bioético y personal. La autoconciencia de estos profesionales sobre sus propias actitudes hacia la eutanasia y su adaptación a los códigos éticos vigentes podría minimizar el impacto generado por estas situaciones y, por tanto, mejorar la relación terapéutica y la calidad asistencial. Por otro lado, el instrumento aporta información sobre la posible recomendación de estas prácticas bajo aparente justificación médica y/o en situaciones basadas en el sufrimiento emocional subjetivo del paciente. Estudios previos indican que los profesionales se ven afectados emocionalmente cuando se enfrentan a los conceptos de muerte y eutanasia en pacientes terminales. En este sentido, la escala también podría servir de evaluación de actitudes y el trabajo en planes de prevención de salud laboral en los centros sanitarios.

Entrega em adoção e demanda de reencontro à justiça: motivações da genitora / Voluntary relinquishment and request to justice for reunion: birth mother's motivations / Entrega en adopción y solicitud de reencuentro a la justicia: motivaciones de la madre biológica

Mudanças legislativas em relação à adoção vêm trazendo importantes repercussões para a compreensão do instituto. Neste artigo, temos como objetivo discutir especificidades da entrega voluntária de uma criança para adoção, no contexto da Justiça, e as motivações de demanda posterior da genitora para a viabilização de um reencontro. Problematizamos a amplitude do direito de acesso às origens, assegurado em lei aos adotados, a partir do entrelaçamento das temáticas entrega e reencontro, procurando compreender essas experiências pela perspectiva da genitora. Este trabalho parte de um caso paradigmático, atendido em uma Vara da Infância, Juventude e Idoso no estado do Rio de Janeiro, que culminou com o contato, mediado pelo Poder Judiciário, entre a adotada e sua genitora, por iniciativa desta. Trata-se de um estudo qualitativo, no qual foi realizada uma entrevista semiestruturada com a genitora, quatro anos após o acolhimento de seu pedido à Justiça. Os dados obtidos na entrevista foram analisados por meio do método de análise de conteúdo, em sua vertente categorial, resultando em duas categorias: entrega em adoção e segredos; reencontro: motivações e trajetórias. Constatamos a ausência de publicações brasileiras sobre a temática do reencontro, apontando que o assunto ainda é um tabu. Identificamos que, após o reencontro com a filha, foi possível à genitora uma transformação de si mesma, favorecendo o rompimento do segredo da entrega e de parte de sua história. Assinalamos a necessidade de mais pesquisas, incluindo-se a possibilidade da inserção do Judiciário na mediação dessas demandas.(AU)

Legislative changes related to adoption have brought important repercussions for understanding its regulations. In this article, we aim to discuss the peculiarities of a voluntary relinquishment of a child for adoption, in the context of justice, and the motivations of subsequent demand from the birth mother to set a reunion. We problematize the dimension of the right to access origins, guaranteed by law to adoptees, based on the intertwining of the themes voluntary relinquishment and reunion, seeking to understand these experiences from the perspective of the biological mother. This work is based on a paradigmatic case, attended at a Juvenile Court in the State of Rio de Janeiro, that culminated on the reunion of the adopted and her birth mother, at the initiative of the latter, mediated by the Judiciary. This is a qualitative study, in which we interviewed the biological mother, four years after her legal requirement. The data obtained in the interview were analyzed using the content analysis method, in its categorical aspect, resulting in two categories: voluntary relinquishment in adoption and secrets; reunion: motivations and trajectories. We concluded the absence of Brazilian studies about the theme of reunion, pointing out that the subject still as a taboo. We identified that, after the reunion with the daughter, it was possible for the biological mother to modify herself, favoring the breaking of the secret about the relinquishment and of part of her story. We point out the need of more research, including the possibility of inserting the Judiciary as a mediator for such demands.(AU)

Los cambios legislativos respecto a la adopción han tenido importantes repercusiones en la comprensión de la materia. Este artículo pretende discutir los detalles de la entrega espontánea de un niño para adopción, en el contexto de la Justicia, y las motivaciones de la posterior demanda de la madre biológica para hacer factible un reencuentro. Se problematiza la amplitud del derecho de acceso a los orígenes, garantizado por la ley a los adoptados, a partir del entrelazamiento de los temas entrega y reencuentro, analizando estas experiencias desde la perspectiva de la madre biológica. Este trabajo parte de un caso paradigmático que se llevó a cabo en un Juzgado de la Infancia, Juventud y Persona Mayor del Estado de Río de Janeiro y que culminó en el contacto entre la adoptada y su madre, por iniciativa de esta última, mediado por el Poder Judicial. Este estudio cualitativo realizó una entrevista semiestructurada con la madre biológica cuatro años después de su solicitud a la Justicia. A los datos obtenidos en la entrevista se aplicaron el método de análisis de contenido en su vertiente categórica, en el cual surgieron dos categorías: entrega en adopción y secretos; reencuentro: motivaciones y trayectorias. Se encontró que la falta de estudios brasileños sobre reencuentro apunta a que el concepto del sujeto todavía es un tabú. Se constató que luego del encuentro la madre biológica pasó por una autotransformación, lo que favoreció la ruptura del secreto sobre la entrega y parte de su historia. Es necesario realizar más investigaciones sobre el tema, incluida la posibilidad de insertar al Poder Judicial como mediador de tales demandas.(AU)

The increase of philanthropic entities in the SUS: what does this scenario reveal? / O aumento de entidades filantrópicas no SUS: o que esse cenário revela?

ABSTRACT The article analyzes aspects of the change in the legal nature of private healthcare from "for-profit" to "non-profit" entities. It is an exploratory research, supported by the policy analysis framework, focusing on secondary data from the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities - CNES) from 2012 to 2020 and a case study. The results show an increase in these entities in all regions of the country and evidence that they behave like profit-oriented entities. The change in legal nature hides a broader process of implicit commodification of healthcare services, encouraged by state policies and related to exemptions provided by law.

RESUMO O artigo analisa aspectos da mudança da natureza jurídica de instituições privadas de assistência à saúde, de estabelecimentos "com" para "sem" fins lucrativos. Trata-se de uma pesquisa exploratória, apoiada no referencial de análise de políticas, com foco em dados secundários, provenientes do Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES), de 2012 a 2020, e estudo de caso. Os resultados apresentam aumento dessas entidades em todas as regiões do país e evidências de que se comportam como estabelecimentos com fins lucrativos. A mudança de natureza jurídica oculta um processo mais amplo de mercantilização implícita dos serviços de saúde, incentivado por políticas estatais e relacionado às isenções previstas em lei.

Conocimiento de los trabajadores de salud sobre la Ley de Interrupción Voluntaria del Embarazo / Knowledge of health workers about the Voluntary Termination of Pregnancy Law

In early 2021, the theoretical and legal framework for the termination of pregnancy was modified. From August 2021 until April 2022, a survey was conducted among 310 healthcare staff from the General Hospital for Acute Care Dr. Teodoro Álvarez (HGATA, for its acronym in Spanish) and the Health & Community Action Center No. 34 (CeSAC Nº 34, for its acronym in Spanish) to assess their knowledge of the subject and their ability to provide an adequate response to patients inquiring about the procedure. Out of the total number of people surveyed, 72.9% were women, the largest age group was 26-35 years old and the most mentioned occupation was "resident" (31.3%). According to their answers, the respondents were divided into two groups: those who were informed (8.7%, n = 27) and those who were uninformed (91.3%, n = 283). 100% of the informed group were able to provide patients with a correct response while only 82,7% of the uninformed group were able to do so. The majority of the respondents (85.5%) deemed it helpful to receive training and updates on voluntary termination of pregnancy in the near future. Most of the healthcare staff from the HGATA and from the CeSAC No. 34 are unaware of the theoretical-legal framework under which the interruption of pregnancy is regulated. The uninformed presented difficulties in providing an appropriate response. These results show the formative deficit that exists in relation to the theoretical-legal framework. This information could be useful for the identification of barriers and facilitators of access to an interruption

A principios del año 2021 fue modificado el marco teórico-legal de la interrupción del embarazo. Entre los meses de agosto 2021 y abril 2022, realizamos una encuesta a 310 trabajadores del Hospital General de Agudos "Dr. Teodoro Álvarez" (HGATA) y del Centro de Salud y Acción Comunitaria Nº 34 (CeSAC Nº 34), con el objetivo de evaluar su conocimiento al respecto y su capacidad de brindar una respuesta acorde ante la demanda de dicha práctica. Del total de las personas encuestadas, el 72.9% fueron mujeres, el rango etario predominante fue el de 26-35 años y la ocupación mayoritariamente referida fue "residente" (31.3%). Entre los encuestados, definimos dos grupos: conocedores (8.7%, n = 27) y no conocedores (91.3%, n = 283). El 100% de los conocedores brindó una respuesta acorde, mientras que, con relación a los no conocedores, el 82.7% pudo hacerlo. La mayoría de los encuestados (85.5%) consideró útil recibir capacitación y actualización sobre esta temática en el futuro. Concluimos que la mayoría de los trabajadores del HGATA y del CeSAC Nº 34 desconocen el marco teórico-legal bajo el cual está reglamentada la interrupción del embarazo. Los no conocedores tuvieron dificultades para brindar una respuesta apropiada. Estos resultados muestran el déficit formativo que existe en relación con el marco teórico-legal de esta práctica. Esta información sería útil para la identificación de barreras y facilitadores de acceso a la interrupción del embarazo.

Uptake of HIV voluntary counseling and testing and associated factors among students in the Higher Institutions of Learning in Kigali, Rwanda: A cross-sectional study

Background HIV/AIDS remains a significant global public health challenge with youth bearing the brunt of the burden. One essential method for preventing and accessing AIDS care is through Voluntary Counselling and Testing (VCT). Regardless of this, youth population continues to have low utilization of VCT services. Objective To assess the uptake of HIV VCT services and associated factors among university students in Kigali. Methods A cross-sectional study among 374 students recruited using stratified sampling was conducted. A structured questionnaire was used to gather information. A multivariable logistic regression analysis was used to assess the independent factors associated with VCT uptake. Results The prevalence of VCT uptake was 59.9%. The logistic regression revealed that being Catholic (AOR = 11.99, 95%CI: 5.44-26.41) and Moslem (AOR = 37.34, 95%CI: 2.67-128.36) compared to Protestant, as well as availability of VCT services (AOR = 5.15, 95%CI: 3.11 - 8.541) favored the use VCT. On the other hand, being aged 20 to 24 years (AOR = 0.112, 95%CI: 0.04 - 0.29) had low likelihood of using VCT than those more than 24 years of age. Conclusion VCT uptake was significantly positively associated with religion and VCT services availability, and negatively associated with age 20-24 years in the campus. Therefore, targeted actions of disseminating information on benefits of VCT and enhancing accessibility of VCT services among students are necessary for the increased VCT uptake to be attained.

Short-term voluntary exercise enhances the activation of endogenous neural stem cells inintracerebral hemorrhage mice with hyperlipidemia / 西安交通大学学报(医学版)

【Objective】 To investigate the improvement of motor function recovery and the activation of endogenous neural stem cells (eNSCs) via voluntary exercise in mice with hyperlipidemia after intracerebral hemorrhage (ICH). 【Methods】 Four-month-old male Nestin-CreERT2: tdTomato transgenic mice were fed with high-fat diet (HFD) for eight weeks. Type Ⅳ collagenase was micro-injected into the corpus striatum to construct mouse ICH model with the help of stereotaxic apparatus. Voluntary exercise (wheel running) was initiated on the second day after ICH and monitored daily for seven days. Neurological severity score (NSS) and beam walking test were applied to evaluate motor function and coordination. Liver and brain tissues were collected at day 9 after ICH and sliced for staining. Then the Nestin-labeled cells, Ki67+, and doublecortin (DCX)+ in subventricular zone (SVZ) were counted to evaluate eNSCs activation. 【Results】 ① Compared with those of mice fed by chow diet (CD), the body weight, blood glucose level, concentration of lipid metabolism factors and the number of Nile Red positive cells in liver tissue were significantly higher in HFD-fed mice, confirming hyperlipidemia. ② Compared with the sham group, NSS score increased and the distance of cross-beam walking of ICH mice significantly decreased, showing the deficiency of motor function. It could be rescued by 7-day wheel running, as shown by a lower NSS score and a longer cross-beam walking distance. ③ Compared with the sham group, the number of Nestin+/Ki67+ cells decreased and Nestin+/DCX+ cells increased after ICH. After 7-day voluntary exercise, the number of Nestin+/Ki67+ cells decreased but that of Nestin+/DCX+ cells further increased significantly. However, compared with ICH, the increase of Nestin+/DCX+ cells in ICH+Ex was not significant. 【Conclusion】 Short-term voluntary exercise during the acute stage of ICH improved the recovery of motor function and enhance the proliferation of eNSCs in mice with hyperlipidemia. This provides a new idea for further developing ICH accelerated rehabilitation strategy based on eNSCs.

Ethical Thinking on Chinese Traditional Culture and Voluntary Blood Donation / 中国医学伦理学

Although voluntary blood donation may be hindered by traditional Chinese culture, Chinese traditional culture does not only have a negative effect on voluntary blood donation. Among them, the concepts of "self-restraint" and "benevolence" can help people devote themselves to voluntary blood donation, but the value pursuit of body integrity in traditional culture is still noteworthy. From the perspective of "sacrificing life for righteousness", the traditional culture’s emphasis on the inviolability of the body is not absolute. Under special circumstances, moderate and slight damage to the body for the public interest is permitted and supported by Confucian ethics. Voluntary blood donation obviously belongs to this special situation, and its legitimacy can be justified by the body ethics advocated by Mencius. "Self-restraint" and "benevolence" are ideological helps to guide people to practice voluntary blood donation.

Correlation between Elbow Flexor Muscle Strength and Needle Electromyography Parameters after Musculocutaneous Nerve Injury / 法医学杂志

OBJECTIVES@#To explore the changes of elbow flexor muscle strength after musculocutaneous nerve injury and its correlation with needle electromyography (nEMG) parameters.@*METHODS@#Thirty cases of elbow flexor weakness caused by unilateral brachial plexus injury (involving musculocutaneous nerve) were collected. The elbow flexor muscle strength was evaluated by manual muscle test (MMT) based on Lovett Scale. All subjects were divided into Group A (grade 1 and grade 2, 16 cases) and Group B (grade 3 and grade 4, 14 cases) according to their elbow flexor muscle strength of injured side. The biceps brachii of the injured side and the healthy side were examined by nEMG. The latency and amplitude of the compound muscle action potential (CMAP) were recorded. The type of recruitment response, the mean number of turns and the mean amplitude of recruitment potential were recorded when the subjects performed maximal voluntary contraction. The quantitative elbow flexor muscle strength was measured by portable microFET 2 Manual Muscle Tester. The percentage of residual elbow flexor muscle strength (the ratio of quantitative muscle strength of the injured side to the healthy side) was calculated. The differences of nEMG parameters, quantitative muscle strength and residual elbow flexor muscle strength between the two groups and between the injured side and the healthy side were compared. The correlation between elbow flexor manual muscle strength classification, quantitative muscle strength and nEMG parameters was analyzed.@*RESULTS@#After musculocutaneous nerve injury, the percentage of residual elbow flexor muscle strength in Group B was 23.43% and that in Group A was 4.13%. Elbow flexor manual muscle strength classification was significantly correlated with the type of recruitment response, and the correlation coefficient was 0.886 (P<0.05). The quantitative elbow flexor muscle strength was correlated with the latency and amplitude of CMAP, the mean number of turns and the mean amplitude of recruitment potential, and the correlation coefficients were -0.528, 0.588, 0.465 and 0.426 (P<0.05), respectively.@*CONCLUSIONS@#The percentage of residual elbow flexor muscle strength can be used as the basis of muscle strength classification, and the comprehensive application of nEMG parameters can be used to infer quantitative elbow flexor muscle strength.

Voluntary blood donation among the youth: Time to consider service-improving strategies?

@#Voluntary blood donation is a key strategy in improving availability of, and access to, a life-saving product for populations requiring blood transfusion for a variety of medical conditions.1 In the Philippines, the value of voluntary blood donation is recognized by the state through Republic Act No. 7719, enacted nearly three decades ago.2 Among others, this piece of legislation aims to encourage citizens to donate blood through educational and advocacy activities that will “instill public consciousness of the principle that blood donation is a humanitarian act.” But is this appeal to altruism sufficient? The repeated calls for action by the Department of Health (DOH), through its National Voluntary Blood Services Program, may indicate otherwise. For instance, it was noted that in 2009, about one in four blood units collected were from replacement donation (i.e., blood donation from family and friends in exchange for stored blood used by a patient).3 The low voluntary blood donation rates were further exacerbated by the pandemic situation amidst a constant demand for blood transfusion, hence the DOH taps its regular donors such as uniformed personnel.4 Stakeholders particularly appealed to the youth to donate blood to boost supply.5,6 But how do the youth fare? In the paper by Mappala et al.7 in this issue of the Acta Medica Philippina, the authors reported that among a sample of relatively young, educated, internet-savvy, and urban-dwelling respondents, only about one in three ever donated blood, and of this number, about two-thirds either donated blood only when needed, or just did the practice once. Most of the respondents have a relatively high knowledge and awareness of blood donation, and were motivated to donate blood for altruistic and pro-social purposes. From this data alone, appealing to humanitarian and civic duty, the very heart of the current national policy and program, appears to be not enough to encourage the practice of blood donation, at least in so far as this population segment is concerned. Other results from the same survey, however, point to one other area that stakeholders in the voluntary blood donation program can focus on to increase uptake by the population, and this is with respect to the availability and accessibility of the service to the target population. Participants rated highly the statements pertaining to the geographic proximity of the facility, attitude of staff towards blood donors, and availability of communication lines for addressing queries, as motivators for blood donation. From a management perspective, these align with the value chain strategic service delivery model, which can be considered by stakeholders in designing the voluntary blood donation service and facility.8 More specifically, blood donation services can look into incorporating value-adding service delivery strategies in their design of their offering, considering the experience of the service user before, during, and after the service has been rendered. These strategies are described in detail elsewhere, and I will just attempt to list down some considerations specific to the blood donation service. Pre-service strategies include market analysis (including market segmentation and differentiation, in this case possibly developing different approaches and messages for target donors such as the youth, older adults, etc.), pricing (while voluntary blood donation is free, some facilities are authorized to charge a fee for the processing of the donated blood), location (of the blood donation facilities, and deciding whether these should be fixed post or mobile units), and promotion (among others, how to inform the target donors about the service). Point-of-service considerations, meanwhile, pertain to the totality of the donor experience from the time they arrive, and eventually leave, the blood donation facility, and encompasses all aspects of clinical operations, quality assurance, process innovation, and patient satisfaction. Lastly, after-service strategies will have to include aspects on how to encourage a person who donated blood once to become a regular donor, as well as an advocate and ambassador for blood donation who can encourage and influence family and friends to likewise donate blood in a voluntary manner (i.e., as part of follow-up and follow-on activities). I write this Editorial on the eve of the 29th year since Republic Act No. 7719 was promulgated. Given the evolving characteristics of the target blood donor pool, this may be the opportune time to shift from focusing purely on promotion of the pro-social value of blood donation, and incorporate service-improving strategies in the blood donation system, to bring us closer to the policy vision of mobilizing “all sectors of the community to participate in mechanisms for voluntary and nonprofit collection of blood.”

Frequency of Transfusion transmissible infections in voluntary and family replacement donors at The Alotau Provincial Health Authority Blood Transfusion Service, Papua New Guinea

@#Transfusion Transmissible Infections (TTI) in blood donors continue to be a threat to recipients, therefore, to increase accessibility to infection-free donor blood, voluntary non-remunerated donation has been recommended. This was a retrospective observational study aimed at establishing a data base for transfusion transmissible infections in family replacement and voluntary donors at the Alotau Provincial Health Authority (PHA) Blood Bank Service using donor data recorded from 2015 to 2018. Statistical significance was determined using the chi-square test with p-values of <0.05 considered significant. Ethical clearance was approved by the School of Medicine and Health Sciences Research Ethics Committee. Consent to collect data from the Alotau PHA Blood Transfusion Service and the Blood Bank Laboratory was granted on the 17/06/2019 reference #: RCO1/6/19. A total of 2852 blood donors were analyzed, of which 90% (n=2567) were males and 10% (n=285) were females. Of these, 69% (n=1959) were Family-Replacement-Donors (FRDs) and 31% (n=893) were Voluntary Donors (VDs). Donations by FRDs increased with increasing years from 2015 to 2017 and declined slightly by 1% in 2018. The complete opposite was observed in VDs. TTIs were higher in FRDs than in VDs (20.1% vs 16.8%, p=0.04), in single infections, (18.6% vs 15.2%, p=0.03), infection with HBV (9.9% vs 7.2%, p=0.02), and in those aged over 45 years (2.7% vs 0.1%, p=<0.01). The differences were statistically significant. TTI was significantly higher in male FRDs than VDs (19.1 vs 14.3, p=0.00) and in females, it was significantly higher in VDs than in FRDs (2.5% vs 1.0%, p=0.00). TTIs were significantly high in older male FRDs which seem to indicate that the primary route of transmission in this setting could be mostly sexual. This calls for establishment of effective educational awareness about risk factors in the older population, and promotion of voluntary non-remunerated donations in this setting.

Research on the Role of Voluntary Service in Cultivating the Medical Professionalism of Medical Freshmen: Text Analysis Based on the "Volunteer Star" Deeds of Peking University Premedical Students / 中国医学伦理学

Based on the content of medical professionalism and the theoretical model of knowledge, belief and practice, this paper used the methods of "inductive category construction" and "deductive category construction" to form the categories and analyze the text, taking the narrative materials of 112 "volunteer stars" outstanding individuals selected by the pre-medical student office of student affairs department of Peking University Health Science Center from 2019 to 2021 as the research subjects. The findings demonstrated that volunteer service had a positive effect on the cultivation of medical professionalism of medical freshmen, and played an effective role in guiding medical freshmen from the two dimensions of knowledge and belief, in which the role of medical voluntary service was more obvious. However, the breadth and depth of volunteer service in cultivating medical professionalism were limited. Based on this, this paper proposed that medical colleges and universities should emphasize voluntary service in the cultivation of medical professionalism, especially the development of medical voluntary service activities designed for medical students, and strengthen the cultivation effect by coordinating with other cultivation methods.

Voluntary blood donation intention of students in middle vocational school in Jinhua and its influencing factors / 中国输血杂志

【Objective】 To explore the intention of voluntary blood donation in students from a middle vocational school in Jinhua and its influencing factors. 【Methods】 A total of 400 students were enrolled from a middle vocational school in Jinhua by convenience sampling, and a self-designed questionnaire was issued to each student to investigate the cognition, intention and attitude of voluntary blood donation. The influencing factors of voluntary blood donation intention were analyzed by Logistic regression. 【Results】 A total of 394 valid questionnaires(98.50%) were collected. For 394 surveyed students, the average score of cognition of voluntary blood donation was (7.27±2.69) points, and the overall rate of intention to voluntary blood donation was 21.32%. Logistic regression analysis equation consisted of family support, better cognition, feeling happy about blood donation and worrying about blood donation, with risk ratios(OR) as 31.78, 188.69, 26.27 and 0.01, respectively(all P<0.05). 【Conclusion】 Students from a middle vocational school showed poor congnition and intention of voluntary blood donation.Family support for voluntary blood donation, better cognition of voluntary blood donation and happiness for blood donation were positive factors, and the fear of blood donation was a negative factor.It is necessary to strengthen the publicity of blood donation among students in middle vocational school to improve their congnition and intention to voluntary blood donation.

Investigation on whole blood collection in Tianjin after fully lifting COVID-19 prevention and control measures / 中国输血杂志

【Objective】 To investigate the situation of whole blood collection in Tianjin after COVID-19 prevention and control measures were fully lifted. 【Methods】 The relevant data on whole blood collection of voluntary blood donors in Tianjin 15 days before Spring Festival (2023.01.07-2023.01.21, when China has managed COVID-19 with measures against Class B infectious disease instead of Class A infectious diseases) and 15 days before Spring Festival in 2018 (2018.02.01- 2018.02.15) and 2019 (2019.01.21-2019.02.04) before the breakout of COVID-19 were retrospectively collected and compared. 【Results】 The comparison between the above period in 2023, 2018 and 2019 was as follows: the number of blood donors was 6 124 vs 3 940 vs 4 069; blood collection volume (U) was 9 623 vs 7 378 vs 7 808; the proportion of first-time blood donors, local blood donors and group blood donors was 69.17% (4 236/6 124) vs 65.86% (2 595/3 940) vs 62.05% (2 525/4 069), 59.31% (3 632/6 124) vs 23.27% (9170) vs 18.19% (740/4 069) and 43.42% (2 659/6 124) vs 8.05% (317/2 595) vs 0.15% (6/4 069) (all P<0.05). 【Conclusion】 The adjustment of COVID-19 prevention and control policy has a significant impact on voluntary blood donation, and the corresponding adjustment of blood donor recruitment strategy in blood centers should be conducted to increase the whole blood collection.

Implementation of points-based household registration policy for voluntary blood donors in Nanjing / 中国输血杂志

【Objective】 To analyze the implementation effect of points-based household registration policy for blood donors in Nanjing, so as to provide reference for other provinces and cities to develop incentive policies for blood donation. 【Methods】 The basic demographic profile, registration situation and deferral reasons of blood donors who applied for points-based household registration from 2017 to 2021 were analyzed by Excel. 【Results】 1) A total of 388 blood donors applied for points-based household registration for blood donation from 2017 to 2021, accounting for 0.042% of the total blood donors in Nanjing (388/923 160), and 357 applications were approved, accounting for 0.039% (357/923 160). 2) The proportion of male applicants was higher than that of female applicants (55.15% vs 44.85%). Applicants aged 26~35 accounted for the largest, followed by applicants aged 36~45, and applicants aged 18~25 accounted for the least. The proportion of applicants in Jiangsu province(23.27%) was higher than that of applicants from other provinces. The top three occupations were employees, workers and jobless. In terms of education level, applicants with junior high school education or below accounted for the largest, followed by high school and secondary school (35.05% vs 29.38% vs 23.20%). The proportion of first-time blood donors was the highest (33.24%). Among the repeated blood donors, blood donors who donated blood 2~3 times were with the highest share (23.93%). Nineteen donors(4.90%) got more than 100 points. 3) A total of 31 blood donors were deferred from 2017 to 2021, accounting for 7.90% of the total applicants. Among them, 23 applicants donated in other cities than Nanjing, 5 applicants failed to provide valid blood donation certificates, and 3 applicants submitted irrelevant material. 【Conclusion】 The implementation of points-based household registration policy for voluntary blood donors in Nanjing helped blood donors who could not reach other points due to low education level and income to become registered permanent residence in Nanjing

Changes of specific antibody and neutralizing antibody after voluntary blood donors received COVID-19 vaccine / 中国输血杂志

【Objective】 To analyze the changes in antibody titer of voluntary blood donors after receiving the COVID-19 vaccine, so as to provide reference for blood donation strategy, follow-up vaccine development and COVID-19 prevention and treatment for healthy people. 【Methods】 1) The serum from voluntary blood donors 2, 4, 8, 12, 16 and 20 weeks after inoculation with two-shot vaccines (inactivated vaccine or recombinant protein vaccine) was collected, and SARS-CoV-2 total antibody (IgG+ IgM+ IgA) detection (colloidal gold method) and neutralizing antibody detection (UPT immunoluminescence method) were conducted. 2) The obtained data were grouped according to collection time, age and gender, and differences between groups were analyzed by t test and ANOVA using SPSS 2.0 statistical software to clarify the trend of total antibodies and neutralizing antibodies. 【Results】 Neutralizing antibodies and total antibodies (IgG+ IgM+ IgA) from voluntary blood donors vaccinated inactivated vaccine or recombinant vaccine had the same trend of change, both reached their peak at the 2nd and 4th week, respectively, after inoculation, and then decreased gradually. The antibody produced by the recombinant protein vaccine had a higher titer than that from inactivated vaccine, and had slower decline and more lasting protection. The neutralizing antibody and total antibody (IgG+ IgM+ IgA) from different genders and ages were not statistically different. 【Conclusion】 Neutralizing antibodies reached its peak in the second week after vaccination, and total antibody titer reached its peak in the fourth week; both were independent of age and gender. After receiving the vaccine, voluntary blood donors should follow the latest instructions on blood donation intervals issued by the government.

Analysis of confidential unit exclusion status of voluntary blood donors in Hefei / 中国输血杂志

【Objective】 To explore the status of confidential unit exclusion(CUE) status among voluntary blood donors in Hefei, so as to provide scientific basis for blood safety. 【Methods】 From 2012 to 2021, 57 out of the 1 158 272 voluntary blood donors in Anhui Blood Center, who requested CUE, were analyzed for population characteristics and their motives in asking for CUE. 【Results】 There were 57(0.004 9%) voluntary blood donors asking for CUE after donation, including 42 males (73.69%) and 15 females (26.32%). All the blood samples were negative in transfusion-transmitted viral marker testing except one positive in syphilis (TP) antibody. The reasons for CUE were as follows: high-risk behaviors (including multiple sexual partners, male-to-male homosexual behaviors, intravenous drug use, etc.) in 23 cases (40.35%), diseases unsuitable for blood donation in 7 cases (12.28%), and other reasons in 14 cases (24.56%). 【Conclusion】 Effective consultation before blood donation is particularly important to ensure blood safety and avoid the waste of blood.