Eccentric Strength Assessment of Hamstring Muscles with New Technologies: a Systematic Review of Current Methods and Clinical Implications.

BACKGROUND: Given the severe economic and performance implications of hamstring injuries, there are different attempts to identify their risk factors for subsequently developing injury prevention strategies to reduce the risk of these injuries. One of the strategies reported in the scientific literature is the application of interventions with eccentric exercises. To verify the effectiveness of these interventions, different eccentric strength measurements have been used with low-cost devices as alternatives to the widespread used isokinetic dynamometers and the technically limited handheld dynamometers. Therefore, the purpose of the present systematic review was to summarize the findings of the scientific literature related to the evaluation of eccentric strength of hamstring muscles with these new technologies. METHODS: Systematic searches through the PubMed, Scopus, and Web of Science databases, from inception up to April 2020, were conducted for peer reviewed articles written in English, reporting eccentric strength of hamstrings assessed by devices, different to isokinetic and handheld dynamometers, in athletes. RESULTS: Seventeen studies were finally included in the review with 4 different devices used and 18 parameters identified. The pooled sample consisted of 2893 participants (97% male and 3% female: 22 ± 4 years). The parameters most used were peak force (highest and average), peak torque (average and highest), and between-limb imbalance (left-to-right limb ratio). There is inconsistency regarding the association between eccentric hamstrings strength and both injury risk and athletic performance. There is no standardized definition or standardization of the calculation of the used parameters. CONCLUSIONS: The current evidence is insufficient to recommend a practical guide for sports professionals to use these new technologies in their daily routine, due to the need for standardized definitions and calculations. Furthermore, more studies with female athletes are warranted. Despite these limitations, the eccentric strength of hamstring muscles assessed by different devices may be recommended for monitoring the neuromuscular status of athletes.

Prevalence of palliative sedation in the State of São Paulo: an emerging medical demand.

OBJECTIVE: To investigate the prevalence of palliative sedation use and related factors. METHODS: An observational study based on data collected via electronic questionnaire comprising 23 close-ended questions and sent to physicians living and working in the state of São Paulo. Demographic data, prevalence and frequency of palliative sedation use, participant's familiarity with the practice and related motivating factors were analyzed. In order to minimize memory bias, questions addressing use frequency and motivating factors were limited to the last year prior to survey completion date. Descriptive statistics were used to summarize data. RESULTS: In total, 20,168 e-mails were sent and 324 valid answers obtained, resulting in 2% adherence. The overall prevalence of palliative sedation use over the course of professional practice was 68%. However, only 48% of respondents reported having used palliative sedation during the last year, primarily to relieve pain (35%). The frequency of use ranged from one to six times (66%) during the study period and the main reason for not using was the lack of eligible patients (64%). Approximately 83% of physicians felt comfortable using palliative sedation but only 26% reported having specific academic training in this field. CONCLUSION: The prevalence of palliative sedation use is high, the primary indication being pain relief. However, frequency of use is low due to lack of eligible patients.

Sleep quality monitoring in individual sports athletes: parameters and definitions by systematic review.

In the present review, we identify which instruments and parameters are used for sleep quality monitoring in individual sport athletes and which definitions were used for sleep quality parameters in this literature field. Systematic searches for articles reporting the qualitative markers related to sleep in team sport athletes were conducted in PubMed, Scopus and Web of Science online databases. The systematic review followed the Preferred Reporting Items for Systematic Reviews. The initial search returned 3316 articles. After the removal of duplicate articles, eligibility assessment, 75 studies were included in this systematic review. Our main findings were that the most widely used measurement instruments were Actigraphy (25%), Rating Likert Scales (16%) and Sleep Diary (13%). On sleep quality parameters (Sleep duration = 14%; Wake after sleep onset = 14%; Sleep Quality = 12%; Sleep Effciency = 11% and Sleep Latency = 9%), the main point is that there are different definitions for the same parameters in many cases reported in the literature. We conclude that the most widely used instruments for monitoring sleep quality were Actigraphy, Likert scales and Sleep diary. Moreover, the definitions of sleep parameters are inconsistent in the literature, hindering the understanding of the sleep-sport performance relationship.

Prevalence of palliative sedation in the State of São Paulo: an emerging medical demand / Prevalência de sedação paliativa no Estado de São Paulo: uma demanda médica emergente

ABSTRACT Objective To investigate the prevalence of palliative sedation use and related factors. Methods An observational study based on data collected via electronic questionnaire comprising 23 close-ended questions and sent to physicians living and working in the state of São Paulo. Demographic data, prevalence and frequency of palliative sedation use, participant's familiarity with the practice and related motivating factors were analyzed. In order to minimize memory bias, questions addressing use frequency and motivating factors were limited to the last year prior to survey completion date. Descriptive statistics were used to summarize data. Results In total, 20,168 e-mails were sent and 324 valid answers obtained, resulting in 2% adherence. The overall prevalence of palliative sedation use over the course of professional practice was 68%. However, only 48% of respondents reported having used palliative sedation during the last year, primarily to relieve pain (35%). The frequency of use ranged from one to six times (66%) during the study period and the main reason for not using was the lack of eligible patients (64%). Approximately 83% of physicians felt comfortable using palliative sedation but only 26% reported having specific academic training in this field. Conclusion The prevalence of palliative sedation use is high, the primary indication being pain relief. However, frequency of use is low due to lack of eligible patients.

RESUMO Objetivo Verificar a prevalência e os fatores associados ao uso de sedação paliativa. Métodos Trata-se de estudo observacional realizado a partir do preenchimento de um questionário eletrônico com 23 questões objetivas enviado a médicos paulistas. Foram avaliados os dados demográficos, a prevalência e a frequência de uso da sedação paliativa; o nível de conhecimento a respeito da técnica; e as motivações para sua utilização. Visando minimizar o viés de recordação, questões sobre a frequência de uso e motivações para tal, as respostas deveriam se referir ao último ano em relação à data de preenchimento da pesquisa. Foi utilizada estatística descritiva para sumarizar os resultados. Resultados Foram enviados 20.168 e-mails e obtiveram-se 324 respostas válidas, resultando em 2% de adesão. A prevalência de utilização da sedação paliativa ao longo do histórico de atuação profissional foi de 68%, mas apenas 48% utilizaram a sedação paliativa no último ano, motivados, principalmente, pela presença de dor no paciente (35%). A frequência de uso foi de uma a seis vezes (66%), e a principal razão para não empregar a sedação paliativa foi a ausência de pacientes elegíveis (64%). Aproximadamente 83% dos médicos sentiam-se confortáveis quanto ao uso de sedação paliativa, mas apenas 26% possuíam formação teórica específica na área. Conclusão A prevalência de uso da sedação paliativa é alta, sendo utilizada, na maioria das vezes, para proporcionar o alívio da dor do paciente. Por outro lado, sua frequência de utilização é baixa, principalmente pela ausência de pacientes elegíveis.

CrossFit Overview: Systematic Review and Meta-analysis.

BACKGROUND: CrossFit is recognized as one of the fastest growing high-intensity functional training modes in the world. However, scientific data regarding the practice of CrossFit is sparse. Therefore, the objective of this study is to analyze the findings of scientific literature related to CrossFit via systematic review and meta-analysis. METHODS: Systematic searches of the PubMed, Web of Science, Scopus, Bireme/MedLine, and SciELO online databases were conducted for articles reporting the effects of CrossFit training. The systematic review followed the PRISMA guidelines. The Oxford Levels of Evidence was used for all included articles, and only studies that investigated the effects of CrossFit as a training program were included in the meta-analysis. For the meta-analysis, effect sizes (ESs) with 95% confidence interval (CI) were calculated and heterogeneity was assessed using a random-effects model. RESULTS: Thirty-one articles were included in the systematic review and four were included in the meta-analysis. However, only two studies had a high level of evidence at low risk of bias. Scientific literature related to CrossFit has reported on body composition, psycho-physiological parameters, musculoskeletal injury risk, life and health aspects, and psycho-social behavior. In the meta-analysis, significant results were not found for any variables. CONCLUSIONS: The current scientific literature related to CrossFit has few studies with high level of evidence at low risk of bias. However, preliminary data has suggested that CrossFit practice is associated with higher levels of sense of community, satisfaction, and motivation.