Psychophysiological Stress Markers During Preseason Among Elite Female Soccer Players.

ABSTRACT: Botelho, R, Abad, CCC, Spadari, RC, Winckler, C, Garcia, MC, and Guerra, RLF. Psychophysiological stress markers during preseason among elite female soccer players. J Strength Cond Res 36(6): 1648-1654, 2022-This study aimed to investigate changes and correlations between mood states and various physiological stress markers after a 7-week preseason period among elite female soccer players. Twenty-four elite female soccer players participated in this study (26.4 ± 3.7 years). Their internal training load, mood states, day and evening salivary testosterone and cortisol concentrations, blood creatine kinase concentration (CK), and heart rate variability (HRV) were assessed during the first week of preseason (PRE), and again 7 weeks after a systematic training period (END). After the preseason, there were significant increases in subject negative mood scales (p ≤ 0.03; Effect Size [ES] > 0.60), total mood scores (p = 0.01; QI = 100/0/0; ES = 1.32), day and evening testosterone and cortisol concentrations (p ≤ 0.03; ES > 0.54), and CK concentrations (p = 0.01; QI = 100/0/0; ES = 1.54). Correlations were found between cortisol and tension (r = 0.53 and 0.60; p ≤ 0.02), cortisol and confusion (r = 0.75; p = 0.01), and cortisol and the LF/HF index of HRV (r = -0.52; p = 0.04). Mood states (except vigor), salivary testosterone, and cortisol concentrations, as well as CK, showed significant changes after a 7-week systematic training system. The cortisol was the factor most highly related to various mood states (including tension and confusion), and with the HRV indices. Coaches and researchers can use these data to design, monitor, and control soccer training programs, in particular throughout the preseason period.

Change of Direction Performance in Elite Players From Different Team Sports.

ABSTRACT: Loturco, I, Pereira, LA, Reis, VP, Abad, CCC, Freitas, TT, Azevedo, PHSM and Nimphius, S. Change of direction performance in elite players from different team sports. J Strength Cond Res 36(3): 862-866, 2022-The primary aim of this study was to examine the differences in change of direction (COD) deficit between elite futsal, soccer, handball, and rugby players. A secondary aim was to compare the performance in both COD and linear speed tests among these athletes. One-hundred sixty-one elite male players from 4 team sports performed a 20-m linear sprint speed and a Zigzag COD speed test. The COD deficit was calculated as the difference between linear and Zigzag test velocities. Differences in COD speed, COD deficit, and sprint velocity were assessed via 1-way analysis of variance. The significance level was set at p < 0.05. Soccer players displayed significantly lower performance than the remaining team sports, and rugby players performed better than all the other groups in the Zigzag COD test. Moreover, the COD deficit was significantly higher in soccer players in comparison with the other disciplines (p < 0.05). No differences were observed in the COD deficit among rugby, futsal, and handball players (p > 0.05). In summary, soccer players were slower than futsal, handball, and rugby players to change direction and presented the greatest COD deficit magnitude. By contrast, the fastest athletes in the COD speed test (rugby players) were not more effective than futsal and handball players at changing direction (as they exhibited similar levels of COD deficit). Coaches should be aware of this evidence, which reinforces previous findings, indicating that very specialized training strategies might be required to improve COD performance in professional athletes.

What teachers need to know and be able to do: A view from teachers, students, and principals in the Brazilian context.

The aim of this study was to determine the main characteristics of a "good teacher" through the use of questionnaires designed to assess teaching skills and competences, considering the point of view of teachers, principals, and students. In total, 82 teachers, 14 principals, and 625 middle-school students from 5 public schools in São Paulo state participated in this study. Two questionnaires were applied, one designed for teachers and principals and the other for students. First, teachers and principals completed their specific questionnaire, after which the other questionnaire was applied to the students. Both questionnaires contained multiple choice questions related to eight distinct subsections. The questions were answered through the use of a Likert scale, varying from 1 ("totally disagree") to 5 ("totally agree"). The comparisons of the frequency of responses among all questionnaire subsections between teachers and principals were analyzed using a Chi-Square and the z-test, with P-values adjusted to the Bonferroni method. The statistical significance level was set as P < 0.05. The subsection "class atmosphere" presented the highest percentage of response "totally agree", closely followed by "professional engagement". Significant differences (P < 0.05) in responses were observed between teachers and principals for "teaching planning and practice", "use of time and material resources to develop classes", and "professional engagement" domains. In summary, it was demonstrated that some teaching characteristics might be more important than others, with some of these characteristics exhibiting significant differences between groups. Nevertheless, it is crucial to emphasize that all assessed educational domains may be recognized as critical teaching qualities, as all of them presented high levels of "totally agree" responses.

Effects of Drop Jumps on 1000-m Performance Time and Pacing in Elite Male and Female Endurance Runners.

PURPOSE: To evaluate the effect of drop jumps (DJs) on performance time and pacing in a field test (ie, 1000 m) commonly used to evaluate endurance runners and to evaluate running and jumping performance in male and female athletes separately. METHODS: Twenty elite endurance runners (male, n = 10, 27.8 [7.0] y, 62.3 [5.2] kg; female, n = 10, 25.9 [5.3] y, 51.7 [4.1] kg) competing in middle- and long-distance events participated in this study. After determination of the box height associated with the best reactive strength index, athletes randomly performed a warm-up with or without the inclusion of 5 DJs with the highest reactive strength index prior to a 1000-m track test. Performance time and pacing (250-m splits) were determined. Countermovement-jump heights at different time points and blood lactate concentration after running tests were also recorded. RESULTS: A "possible" faster 1000-m time (162.4 vs 165.3 s) with a "very likely" faster first split (38.8 vs 40.3 s) was observed in male athletes in the DJ condition. In contrast, female athletes showed a "possible" slower running time (186.8 vs 184.8 s) and a "likely" greater blood lactate concentration after the 1000-m test in the DJ condition. Male and female athletes presented greater countermovement-jump performances after warm-up and running tests in both conditions. CONCLUSIONS: The inclusion of 5 DJs with the height associated with the best reactive strength index induced a "possible" improvement in 1000-m performance time in elite male endurance runners. The current protocol should be avoided in female athletes.

Centesimal Age and Relative Age Effect in Elite Futsal Players.

To investigate centesimal age (CA) and relative age effect (RAE) in elite male futsal players their date of birth and court-position were accessed through the official FIFA website. The absolute and relative frequency distributions of player births were quantified by quartiles and semesters. The two-way ANOVA and the Chi-Square analysis were applied to check for possible differences. The results showed a mean CA of 27.76 ± 4.11 years with no differences for both playing positions and competitions. In addition, no significant differences were found between quartiles or between semesters. The results suggest that elite male futsal athletes reach optimal competitive performance close to 27 years. Neither playing position nor geographical location may affect RAE, which seems to not affect the competitive performance (ranking) of elite male futsal players. These findings may help practitioners to understand the RAE phenomenon in futsal. In conclusion, being born in the early months of the year appears not to be important to successful performances in futsal. Overall, futsal athletes take about two decades to achieve their best performance. Coaches and researchers should consider the implementation of long-term training strategies (≈ 20 years) to progressively and effectively develop young futsal players.

Is Tensiomyography-Derived Velocity of Contraction a Sensitive Marker to Detect Acute Performance Changes in Elite Team-Sport Athletes?

PURPOSE: To examine the variations in the velocity of contraction (Vc) assessed using tensiomyography, vertical jumping ability, and sprinting speed induced by 4 different exercise protocols (ie, strength, sprint, plyometric, and technical training sessions) in 14 male national-team rugby players (age 21.8 [2.6] y, weight 83.6 [8.5] kg, and height 177.4 [6.7] cm). METHODS: Physical tests were conducted immediately before and after 4 distinct workouts in the following order: tensiomyography in the rectus femoris and biceps femoris muscles, squat and countermovement jumps, and 30-m sprint velocity. To analyze the differences in the assessed variables before and after each training session, the differences based on magnitudes were calculated. RESULTS: After strength and plyometric workouts, the players presented possible to almost certain impairments in sprint and jump performance and in the Vc of the rectus femoris (effect sizes 0.26-0.64). After the sprint-training session, possible to very likely decreases were observed in the squat jump, 30-m sprint, and Vc of the biceps femoris (effect sizes 0.21-0.44). By contrast, after the technical training, athletes demonstrated a possible increase in the squat jump and Vc in both muscles examined (effect sizes 0.13-0.20). CONCLUSIONS: The main finding of this research is that, for the vast majority of results, the direction of changes observed in Vc were the same as those observed in performance assessments. This suggests that Vc might be used as a sensitive marker of acute variations in speed and power performance of elite team-sport athletes.

Do asymmetry scores influence speed and power performance in elite female soccer players?

This study examined the relationships between vertical jump asymmetries and speed and power performance in elite female soccer athletes. Sixteen professional female soccer players (age: 23.0 ± 3.8 years; body mass: 60.2 ± 7.3 kg; height: 165.1 ± 5.5 cm) from the same professional club participated in this study. Athletes performed unilateral and bilateral squat jumps (SJ) and countermovement jumps (CMJ) on a portable force plate; 30-m sprinting test; Zigzag change-of-direction (COD) test; and muscle power testing using the jump squat (JS) exercise. Asymmetry scores were obtained from the results of the unilateral SJ and CMJ by the percentage difference between the dominant and non-dominant legs. The Pearson product-moment coefficient of correlation was used to analyse the correlations between the bilateral and unilateral vertical jump variables and the physical tests. The bilateral vertical jump performance (in both SJ and CMJ) was closely related to sprinting and JS power performances (r values ranging from 0.50 to 0.73; P< 0.05). In contrast, no significant associations were found between jump asymmetries and performance measures. Our data suggest that asymmetry scores derived from unilateral vertical jumps are not capable of influencing the speed-power performance of professional female soccer players.

Selective Influences of Maximum Dynamic Strength and Bar-Power Output on Team Sports Performance: A Comprehensive Study of Four Different Disciplines.

This study examined the selective influences of one-repetition maximum (1RM) values [assessed in the half-squat (HS)] and bar-power production [assessed in both HS and jump squat (JS) exercises] on the physical performance of male and female team sport athletes from four different sports. Three-hundred and three elite players (31 Olympians) from four different disciplines (47 male soccer players, 58 female soccer players, 28 male handball players, 58 female handball players, 49 male rugby players, and 63 male futsal players) participated in this study. The physical tests were performed over 2 consecutive days for soccer and rugby players, and in 1 day for the remaining athletes. On the first day, rugby and soccer athletes performed squat jumps (SJ), countermovement jumps (CMJ), and HS 1RM. On the second day, they executed HS and JS tests (to assess the maximum bar-power output) and the linear and change-of-direction (COD) speed tests. For the other players, the sequence of the measurements was the same; however, they did not perform the HS exercise. Athletes were separated, using a median split analysis, into two distinct groups, according to their bar-power output in both JS and HS exercises and their performance in HS 1RM. The magnitude-based inferences method was used to examine the differences between "higher" and "lower" performance groups. Overall, the bar-power outputs were better connected to improved acceleration, speed, and jump performance than the 1RM measures. From these findings, it is possible to infer that players able to produce higher bar-power outputs are likely to sprint faster and jump higher. Therefore, coaches involved in team sports are strongly encouraged to use the bar-power method to evaluate the athletic performance of their players.

10 km running performance predicted by a multiple linear regression model with allometrically adjusted variables.

The aim of this study was to verify the power of VO2max, peak treadmill running velocity (PTV), and running economy (RE), unadjusted or allometrically adjusted, in predicting 10 km running performance. Eighteen male endurance runners performed: 1) an incremental test to exhaustion to determine VO2max and PTV; 2) a constant submaximal run at 12 km·h-1 on an outdoor track for RE determination; and 3) a 10 km running race. Unadjusted (VO2max, PTV and RE) and adjusted variables (VO2max0.72, PTV0.72 and RE0.60) were investigated through independent multiple regression models to predict 10 km running race time. There were no significant correlations between 10 km running time and either the adjusted or unadjusted VO2max. Significant correlations (p < 0.01) were found between 10 km running time and adjusted and unadjusted RE and PTV, providing models with effect size > 0.84 and power > 0.88. The allometrically adjusted predictive model was composed of PTV0.72 and RE0.60 and explained 83% of the variance in 10 km running time with a standard error of the estimate (SEE) of 1.5 min. The unadjusted model composed of a single PVT accounted for 72% of the variance in 10 km running time (SEE of 1.9 min). Both regression models provided powerful estimates of 10 km running time; however, the unadjusted PTV may provide an uncomplicated estimation.

Combination of general and specific warm-ups improves leg-press one repetition maximum compared with specific warm-up in trained individuals.

Accurate assessment of muscular strength is critical for exercise prescription and functional evaluation. The warm-up protocol may affect the precision of the 1 repetition maximum (1RM) test. Testing guidelines recommend performing both general and specific warm-ups before strength tests. The general warm-up intends to raise muscle temperature, whereas the specific warm-up aims to increase neuromuscular activation. Although there is scientific evidence for performing the specific warm-up, the effects of general warm-up on strength tests are still unclear. The purpose of this study was to investigate whether the combination of a general with a specific warm-up (G + SWU) protocol would improve leg press 1RM values compared with a specific warm-up (SWU) protocol. Thirteen participants were tested for leg-press 1RM under 2 warm-up conditions. In the first condition, participants performed the SWU only, which was composed of 1 set of 8 repetitions at approximately 50% of the estimated 1RM followed by another set of 3 repetitions at 70% of the estimated 1RM. In the second condition (G + SWU), participants performed the 1RM test after a 20-minute general warm-up on a stationary bicycle at 60% of HRmax and the same specific warm-up as in the SWU. Values of 1RM in SWU and in G + SWU were compared by a paired t-test, and significance level was set at p ≤ 0.05. Strength values were on average 8.4% (p = 0.002) higher in the G + SWU compared with the SWU. These results suggest that the G + SWU induced temperature-dependent neuromuscular adjustments that increased muscle force production capacity. Therefore, these results support the recommendations of the testing guidelines to perform a moderate intensity general warm-up in addition to the specific warm-up before maximum strength assessments.

Implementation of a cardiology care program in remote areas in Brazil: influence of governability.

INTRODUCTION: A telecardiology remote cardiology medical care system was implemented in 82 municipalities of Minas Gerais State, Brazil to support basic network services in the early diagnosis and management of cardiovascular diseases. OBJECTIVE: To investigate the factors associated with the implementation of this program in the municipalities. METHOD: This 2006 ecological study involved 393 candidate municipalities to implement the system. The municipalities were divided into two groups: non-random intervention (n = 82) and comparative (n = 311). The social, structure, healthcare needs, and governability indexes of the two groups of municipalities were compared by descriptive and multiple regression analysis using the generalized estimation equation model. RESULTS: After fitting for other characteristics, participation of the municipalities in the intervention was associated with a higher social responsibility index (OR: 2.44, CI: 1.50-3.96) and lower healthcare needs (OR: 2.29, CI: 1.24-4.22). CONCLUSION: Greater efforts by municipality management was the key to attracting and implementing the remote cardiology intervention, even when fitted for lower healthcare needs, which suggests greater municipal political and social engagement. This translated to improved access to cardiovascular health care for Brazilian rural and remote populations in the intervention municipalities.

Fatores associados com os tipos de heparina usados no tratamento da angina instável em um hospital brasileiro / Factors Associated with the Types of Heparin used in the Treatment of Unstable Angina at a Brazilian Hospital

Unfractionated heparin (UFH) and low-molecularweight heparins (LMWHs) are widely used in curative and preventive treatments of thromboembolic disorders. The aim of the study was to investigate factors associated with the choice of these types of heparin to treat patients with unstable angina under real conditions of hospital use. A cross-sectional study was performed in a private general hospital in Belo Horizonte, Brazil, from January 1st to December 31th, 2001. Data were collected from the hospital electronic database. Inpatients with angina who received enoxaparin or UFH were included in the survey. Data for 555 patients were recorded, including 401 treated with enoxaparin and 154 with UFH. Univariate analysis showed that male and elderly people predominated in both groups, with no statistical difference in the proportions (p>0.05). Multivariate analysis showed 4 factors associated with the use of enoxaparin: cardiac revascularization surgery (OR=0.434), arrhythmias (OR=9.343), risk factors for coronary artery disease (OR=1.333) and private health insurance (OR=0.297). Thus, clinical and organizational factors were associated with the type of heparin used by patients with unstable angina at this hospital. Further drug utilization studies are necessary to expand and improve the data available on the use of heparins in the hospital setting.

A heparina não-fracionada (HNF) e heparinas de baixo peso molecular (HBPM) são amplamente utilizadas em tratamentos curativos e preventivos de tromboembolismo. O objetivo do estudo foi investigar os fatores associados com a escolha desses tipos de heparinas para tratar pacientes com angina instável sob as condições reais de uso hospitalar. Trata-se de um estudo transversal realizado em hospital geral privado, na cidade de Belo Horizonte,MG Brasil, no período de Janeiro a Dezembro de 2001. Para a coleta de dados, utilizou-se o banco de dados informatizado do referido hospital. Pacientes internados com angina que receberam enoxaparina ou HNF foram incluídos no estudo. Registrou-se dados de 555 pacientes, incluindo 401 tratados com enoxaparina e 154 com HNF. Na análise univariada, observouse que o gênero masculino e pacientes idosos foram predominantes em ambos os grupos, sem diferença estatística entre as proporções (p>0,05). A análise multivariada revelou quatro fatores associados ao uso de enoxaparina: cirurgia de revascularização cardíaca (OR=0,434), arritmias (OR=9,343), fatores de risco para doença coronariana (OR=1,333) e atendimento por plano de saúde (OR=0,297). Assim, fatores clínicos e organizacionais estão associados com o tipo de heparina usado por pacientes com angina instável, neste hospital. A realização de mais estudos de utilização de medicamentos é necessária para aprimorar o conhecimento sobre o uso de heparinas, em hospitais.

Utilização prévia de antiinflamatórios não-esteróides por pacientes encaminhados para endoscopia em um hospital universitário brasileiro / Use of nonsteroidal anti-inflammatory drugs by patients before undergoing to endoscopy in a Brazilian university hospital

O estudo teve como objetivo descrever o padrão de uso de antiinflamatórios não-esteróides (AINE) por pacientes encaminhados para endoscopia digestiva alta no Hospital das Clínicas/UFMG, Belo Horizonte/MG. Trata-se de um estudo transversal de uma amostra de 533 pacientes com idade igual ou superior a 17 anos, com endoscopia previamente marcada. Os dados foram coletados por meio de questionário padronizado. As variáveis estudadas foram relativas aos antiinflamatórios não-esteróidese ao seu modo de uso. Cerca de 34% dos entrevistados relatou uso de AINE no período de um mês anterior à endoscopia. Os AINE mais utilizados foram o ácido acetilsalicílico e o diclofenaco e o uso caracterizou-se, principalmente, pela forma esporádica e por período inferior a sete dias. Entre os AINE que foram utilizados por período prolongado, foram mais frequentes o uso em dose diária elevada e o uso de mais de uma especialidade. Evidenciou-se um cenário de utilização inadequada destes medicamentos entre os pacientes estudados, caracterizado pelo uso de especialidades desaconselhadas, uso de AINE em indicações inadequadas, uso de associações medicamentos as questionáveis e uso desnecessário de especialidades dispendiosas em detrimento daquelas seguras e mais acessíveis. Os resultados apontam para a necessidade de estudos adicionais, a fim de maior aprofundamento no conhecimento dessa questão no Brasil.

The objective of this study was to describe the pattern of use of nonsteroidal anti-inflammatory drugs (NSAIDs) among patients referred for upper endoscopy at the Teaching Hospital of the Federal University of Minas Gerais, Belo Horizonte, Brazil. This cross-sectional survey included 533 patients, aged 17 or older, whose endoscopies had been previously scheduled. A standardized questionnaire was used to collect the data, which related to the nonsteroidal anti-inflammatory drugs taken and the way in which they were used. Almost 34% of the interviewed subjects reported having taken NSAIDs during the month prior to the endoscopy. The NSAIDs used most were acetylsalicylic acid and diclofenac and their pattern of use was characterized, in the main, by sporadic use over a period of less than seven days. Among the NSAIDs taken for long periods of time (> 30 dias), a commonly observed pattern was high daily doses and more than one kind of drug. The general picture that emerged was of inappropriate use of these medicines among the studied patients, typically the use of non-recommended types of drug, inappropriate use of NSAIDs for certain conditions, use of questionable drug combinations and the unnecessary use of expensive drugs despite the availability of safer and cheaper alternatives. The results point to the need to carry out more research, to improve our understanding of this question in Brazil.

High incidence of adverse reactions to initial antiretroviral therapy in Brazil.

A concurrent prospective study was conducted from 2001 to 2003 to assess factors associated with adverse reactions among individuals initiating antiretroviral therapy at two public referral HIV/AIDS centers in Belo Horizonte, MG, Brazil. Adverse reactions were obtained from medical charts reviewed up to 12 months after the first antiretroviral prescription. Cox proportional hazard model was used to perform univariate and multivariate analyses. Relative hazards (RH) were estimated with 95% confidence intervals (CI). Among 397 charts reviewed, 377 (95.0%) had precise information on adverse reactions and initial antiretroviral treatment. Most patients received triple combination regimens including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. At least one adverse reaction was recorded on 34.5% (N = 130) of the medical charts (0.17 adverse reactions/100 person-day), while nausea (14.5%) and vomiting (13.1%) were the most common ones. Variables independently associated with adverse reactions were: regimens with nevirapine (RH = 1.78; 95% CI = 1.07-2.96), indinavir or indinavir/ritonavir combinations (RH = 2.05; 95% CI = 1.15-3.64), female patients (RH = 1.93; 95% CI = 1.31-2.83), 5 or more outpatient visits (RH = 1.94; 95% CI = 1.25-3.01), non-adherence to antiretroviral therapy (RH = 2.38; 95% CI = 1.62-3.51), and a CD4+ count of 200 to 500 cells/mm3 (RH = 2.66; 95% CI = 1.19-5.90). An independent and negative association was also found for alcohol use (RH = 0.55; 95% CI = 0.33-0.90). Adverse reactions were substantial among participants initiating antiretroviral therapy. Specially elaborated protocols in HIV/AIDS referral centers may improve the diagnosis, management and prevention of adverse reactions, thus contributing to improving adherence to antiretroviral therapy among HIV-infected patients.

High incidence of adverse reactions to initial antiretroviral therapy in Brazil

A concurrent prospective study was conducted from 2001 to 2003 to assess factors associated with adverse reactions among individuals initiating antiretroviral therapy at two public referral HIV/AIDS centers in Belo Horizonte, MG, Brazil. Adverse reactions were obtained from medical charts reviewed up to 12 months after the first antiretroviral prescription. Cox proportional hazard model was used to perform univariate and multivariate analyses. Relative hazards (RH) were estimated with 95 percent confidence intervals (CI). Among 397 charts reviewed, 377 (95.0 percent) had precise information on adverse reactions and initial antiretroviral treatment. Most patients received triple combination regimens including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. At least one adverse reaction was recorded on 34.5 percent (N = 130) of the medical charts (0.17 adverse reactions/100 person-day), while nausea (14.5 percent) and vomiting (13.1 percent) were the most common ones. Variables independently associated with adverse reactions were: regimens with nevirapine (RH = 1.78; 95 percent CI = 1.07-2.96), indinavir or indinavir/ritonavir combinations (RH = 2.05; 95 percent CI = 1.15-3.64), female patients (RH = 1.93; 95 percent CI = 1.31-2.83), 5 or more outpatient visits (RH = 1.94; 95 percent CI = 1.25-3.01), non-adherence to antiretroviral therapy (RH = 2.38; 95 percent CI = 1.62-3.51), and a CD4+ count of 200 to 500 cells/mm³ (RH = 2.66; 95 percent CI = 1.19-5.90). An independent and negative association was also found for alcohol use (RH = 0.55; 95 percent CI = 0.33-0.90). Adverse reactions were substantial among participants initiating antiretroviral therapy. Specially elaborated protocols in HIV/AIDS referral centers may improve the diagnosis, management and prevention of adverse reactions, thus contributing to improving adherence to antiretroviral therapy among HIV-infected patients.

Health care utilization and survival among patients with AIDS in Belo Horizonte, Minas Gerais, Brazil.

A historical cohort study was conducted in three public AIDS referral services in Belo Horizonte, Minas Gerais, to assess the relationship between health care utilization and patient survival following AIDS diagnosis. A review of medical and laboratory records was performed for HIV-infected patients seeking care for the first time in 1989-92. Among 291 patients initially categorized as 'A' [asymptomatic, acute HIV, or persistent generalized lymphadenopathy-PGL] or 'B' [symptomatic, non-'A', or AIDS-indicator conditions] (CDC, 1992) and who progressed to AIDS, 57.0% died. Mortality rate was 34.9 person-months. Overall median survival time following AIDS diagnosis was 14.3 months. Multivariate analysis showed that lack of AZT use (RR=1.87; 95% CI=1.34-2.61), advanced initial staging (RR=1.68; 95% CI=1.20-2.35), 9 or more inpatient days (RR=1.55; 95% CI=1.11-2.17), and intervals between outpatient visits longer than 6 months (RR=0.30; 95%CI= 0.16-0.56) were associated with death. The analysis suggests that: Patients who used health services more often had poorer prognosis; Patients who received AZT survived longer than those who did not; and variables used to assess health care utilization actually express the end of a process involving seeking and obtaining care.