El entrenamiento de la lucha olímpica para el desarrollo personal y social en adolescentes: una propuesta extracurricular desde la Educación Física / Treinamento da luta-livre olímpica para o desenvolvimento pessoal e social dos adolescentes: uma proposta extracurricular de Educação Física / The training in the Olympic Wrestling for the social and personal development in teenagers: an extracurricular proposal from the Physical Education

RESUMEN El objetivo de este artículo es presentar una propuesta educativa, basada en el entrenamiento de la lucha olímpica para el desarrollo personal y social en adolescentes, en escenarios extracurriculares. Para ello, se utilizaron las metodologías: etnográfica y documental, con la finalidad de poder contestar a la interrogante: ¿Puede haber desarrollo personal y social al entrenar la lucha libre en las instituciones educativas? Se aplicó la revisión bibliográfica en dos fases: la primera, denominada fase I, permitió el análisis de las unidades temáticas seleccionadas para luego asumir una fase II la cual fue propositiva con base en la argumentación teórica y la contextualización que permitiera presentar los objetivos, la metodología pedagógica, la relación con el currículo oficial de Educación Física, las actividades generales y la evaluación para completar algunos vacíos de información. Se aplicó la entrevista a diez profesores de Educación Física de instituciones educativas de la región costa; todos ellos exdeportistas de lucha libre. Ambos instrumentos se basaron bajo dos dimensiones: la primera la lucha olímpica, entre lo curricular y lo extracurricular y la segunda, la lucha olímpica en la formación personal y social del adolescente. Después de hacer un análisis crítico a los resultados, se pudo obtener la propuesta extracurricular de lucha libre. Se aborda la importancia de la implementación de la lucha olímpica como actividad innovadora extracurricular, que potencia el desarrollo personal en cuanto a la autoestima, autocontrol y cuidado de sí mismo, así como habilidades sociales de cooperación, respeto a las reglas y cuidado del otro.

RESUMO O objetivo deste artigo é apresentar uma proposta educativa, baseada na formação da luta olímpica para o desenvolvimento pessoal e social dos adolescentes, em contextos extracurriculares. Para este efeito, foram utilizadas as seguintes metodologias: etnográfica e documental, a fim de responder à pergunta: Pode haver desenvolvimento pessoal e social na formação de luta livre em instituições de ensino? A revisão bibliográfica foi aplicada em duas fases: a primeira, chamada fase I, permitiu a análise das unidades temáticas selecionadas e depois assumir uma fase II que foi propositiva com base na argumentação teórica e na contextualização que permitiu apresentar os objetivos, a metodologia pedagógica, a relação com o currículo oficial da Educação Física, as atividades gerais e a avaliação para completar algumas lacunas de informação. A entrevista foi conduzida com dez professores de Educação Física de instituições educativas da região da costa, todos eles ex-atletas de luta-livre. Ambos os instrumentos se baseavam em duas dimensões: a primeira era a luta olímpica, entre o curricular e extracurricular, e a segunda, a luta olímpica na formação pessoal e social do adolescente. Após uma análise crítica dos resultados, foi obtida a proposta de luta livre extracurricular. É abordada a importância da implementação da luta livre olímpica como actividade extracurricular inovadora, que potência o desenvolvimento pessoal em termos de autoestima, autocontrolo e autocuidado, bem como competências sociais de cooperação, respeito pelas regras e cuidados com os outros.

ABSTRACT The objective of this article is to present an educational proposal based on Olympic Wrestling training for personal and social development in teenagers in extracurricular settings. For this, the ethnographic and documentary methodologies were used in order to answer the question, can there be personal and social development when training wrestling in educational institutions? The bibliographic review was applied in two phases, the first one, called phase I, allowed the analysis of the selected thematic units to later assume a phase II, which was propositional based on the theoretical argumentation and the contextualization that allowed to present the objectives, the pedagogical methodology, the relationship with the official Physical Education curriculum, general activities and evaluation; to fill in some information gaps, the interview was applied to ten physical education teachers from educational institutions in the Costa region, all of them former wrestling athletes. Both instruments were based on two dimensions: the first one, The Olympic Wrestling: between the curricular and the extracurricular, and the second one, The Olympic wrestling in the personal and social formation of the teenagers. After a critical analysis of the results, the extracurricular wrestling proposal was obtained. It addresses the importance of implementing Olympic Wrestling as an innovative extracurricular activity, which promotes personal development in terms of self-esteem, self-control and self-care, as well as social skills of cooperation, respect for rules and care for others.

Methods for Building and Validating Equations for Physiology-Based Mathematical Models: Glucose Metabolism and Type 2 Diabetes in the Archimedes Model.

OBJECTIVES: Describe steps for deriving and validating equations for physiology processes for use in mathematical models. Illustrate the steps using glucose metabolism and Type 2 diabetes in the Archimedes model. METHODS AND RESULTS: The steps are as follows: identify relevant variables, describe their relationships, identify data sources that relate the variables, correct for biases in data sources, use curve fitting algorithms to estimate equations, validate the accuracy of curve fitting against empirical data, perform partially and fully independent external validations, examine any discrepancies to determine causes and make corrections, and periodically update and revalidate equations as necessary. Specific methods depend on the available data. Specific data sources and methods are illustrated for equations that represent the cause of Type 2 diabetes and its effect on fasting plasma glucose in the Archimedes model. Methods for validating the equations are illustrated. Applications enabled by including physiological equations in healthcare models are discussed. CONCLUSIONS: The methods can be used to derive equations that represent the relationships between physiological variables and the causes of diseases and that validate well against empirical data.

Evidencing Continual Professional Development: Maximising Impact and Informing Career Planning.

Continuing professional development (CPD) is essential for radiographers to maintain and update their specialised knowledge base in light of constant professional changes. CPD is the continuous and systematic maintenance, improvement, and broadening of knowledge and skills and the development of personal qualities necessary for the execution of professional and technical duties. Professional and regulatory bodies are increasingly relying on proof of CPD through a variety of learning opportunities to provide evidence of clinical competence. Importantly, CPD has been linked not only to competence but also to motivation and job satisfaction. However, for CPD to be embraced fully, the individual needs to see how activity can be planned and recorded in a way that is meaningful to them in the context of their career aspirations. This article will review basic principles of why evidence is needed for CPD, what constitutes evidence (direct and indirect), and how that evidence can be presented. This will be discussed in the context of having a longer-term career vision, and embedded within Donner and Wheeler's five-phase career planning and development model.

Questionnaire to assess relevance and credibility of modeling studies for informing health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report.

The evaluation of the cost and health implications of agreeing to cover a new health technology is best accomplished using a model that mathematically combines inputs from various sources, together with assumptions about how these fit together and what might happen in reality. This need to make assumptions, the complexity of the resulting framework, the technical knowledge required, as well as funding by interested parties have led many decision makers to distrust the results of models. To assist stakeholders reviewing a model's report, questions pertaining to the credibility of a model were developed. Because credibility is insufficient, questions regarding relevance of the model results were also created. The questions are formulated such that they are readily answered and they are supplemented by helper questions that provide additional detail. Some responses indicate strongly that a model should not be used for decision making: these trigger a "fatal flaw" indicator. It is hoped that the use of this questionnaire, along with the three others in the series, will help disseminate what to look for in comparative effectiveness evidence, improve practices by researchers supplying these data, and ultimately facilitate their use by health care decision makers.

A standardized vascular disease health check in europe: a cost-effectiveness analysis.

BACKGROUND: No clinical trials have assessed the effects or cost-effectiveness of health check strategies to detect and manage vascular disease. We used a mathematical model to estimate the cost-effectiveness of several health check strategies in six European countries. METHODS: We used country-specific data from Denmark, France, Germany, Italy, Poland, and the United Kingdom to generate simulated populations of individuals aged 40-75 eligible for health checks in those countries (e.g. individuals without a previous diagnosis of diabetes, myocardial infarction, stroke, or serious chronic kidney disease). For each country, we used the Archimedes model to compare seven health check strategies consisting of assessments for diabetes, hypertension, lipids, and smoking. For patients diagnosed with vascular disease, treatment was simulated in a standard manner. We calculated the effects of each strategy on the incidence of type 2 diabetes, major adverse cardiovascular events (MACE), and microvascular complications in addition to quality of life, costs, and cost per quality-adjusted life-year (QALY). RESULTS: Compared with current care, health checks reduced the incidence of MACE (6-17 events prevented per 1000 people screened) and diabetes related microvasular complications (5-11 events prevented per 1000 people screened), and increased QALYs (31-59 discounted QALYs) over 30 years, in all countries. The cost per QALY of offering a health check to all individuals in the study cohort ranged from €14903 (France) to cost saving (Poland). Pre-screening the population and offering health checks only to higher risk individuals lowered the cost per QALY. Pre-screening on the basis of obesity had a cost per QALY of €10200 (France) or less, and pre-screening with a non-invasive risk score was similar. CONCLUSIONS: A vascular disease health check would likely be cost effective at 30 years in Denmark, France, Germany, Italy, Poland, and the United Kingdom.

The 'Global Outcomes Score': a quality measure, based on health outcomes, that compares current care to a target level of care.

The quality of health care is measured today using performance measures that calculate the percentage of people whose health conditions are managed according to specified processes or who meet specified treatment goals. This approach has several limitations. For instance, each measure looks at a particular process, risk factor, or biomarker one by one, and each uses sharp thresholds for defining "success" versus "failure." We describe a new measure of quality called the Global Outcomes Score (GO Score), which represents the proportion of adverse outcomes expected to be prevented in a population under current levels of care compared to a target level of care, such as 100 percent performance on certain clinical guidelines. We illustrate the use of the GO Score to measure blood pressure and cholesterol care in a longitudinal study of people at risk of atherosclerotic diseases, or hardening of the arteries. In that population the baseline GO Score was 40 percent, which indicates that the care being delivered was 40 percent as effective in preventing myocardial infarctions and strokes as our target level of care. The GO Score can be used to assess the potential effectiveness of different interventions such as prevention activities, tests, and treatments.

A simulation shows limited savings from meeting quality targets under the Medicare Shared Savings Program.

The Medicare Shared Savings Program, created under the Affordable Care Act, will reward participating accountable care organizations that succeed in lowering health care costs while improving performance. Depending on how the organizations perform on several quality measures, they will "share savings" in Medicare Part A and B payments-that is, they will receive bonus payments for lowering costs. We used a simulation model to analyze the effects of the Shared Savings Program quality measures and performance targets on Medicare costs in a simulated population of patients ages 65-75 with type 2 diabetes. We found that a ten-percentage-point improvement in performance on diabetes quality measures would reduce Medicare costs only by up to about 1 percent. After the costs of performance improvement, such as additional tests or visits, are accounted for, the savings would decrease or become cost increases. To achieve greater savings, accountable care organizations will have to lower costs by other means, such as through improved use of information technology and care coordination.

Model transparency and validation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--7.

Trust and confidence are critical to the success of health care models. There are two main methods for achieving this: transparency (people can see how the model is built) and validation (how well the model reproduces reality). This report describes recommendations for achieving transparency and validation developed by a taskforce appointed by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making. Recommendations were developed iteratively by the authors. A nontechnical description--including model type, intended applications, funding sources, structure, intended uses, inputs, outputs, other components that determine function, and their relationships, data sources, validation methods, results, and limitations--should be made available to anyone. Technical documentation, written in sufficient detail to enable a reader with necessary expertise to evaluate the model and potentially reproduce it, should be made available openly or under agreements that protect intellectual property, at the discretion of the modelers. Validation involves face validity (wherein experts evaluate model structure, data sources, assumptions, and results), verification or internal validity (check accuracy of coding), cross validity (comparison of results with other models analyzing the same problem), external validity (comparing model results with real-world results), and predictive validity (comparing model results with prospectively observed events). The last two are the strongest form of validation. Each section of this article contains a number of recommendations that were iterated among the authors, as well as among the wider modeling taskforce, jointly set up by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making.

Model transparency and validation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-7.

Trust and confidence are critical to the success of health care models. There are two main methods for achieving this: transparency (people can see how the model is built) and validation (how well it reproduces reality). This report describes recommendations for achieving transparency and validation, developed by a task force appointed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Society for Medical Decision Making (SMDM). Recommendations were developed iteratively by the authors. A nontechnical description should be made available to anyone-including model type and intended applications; funding sources; structure; inputs, outputs, other components that determine function, and their relationships; data sources; validation methods and results; and limitations. Technical documentation, written in sufficient detail to enable a reader with necessary expertise to evaluate the model and potentially reproduce it, should be made available openly or under agreements that protect intellectual property, at the discretion of the modelers. Validation involves face validity (wherein experts evaluate model structure, data sources, assumptions, and results), verification or internal validity (check accuracy of coding), cross validity (comparison of results with other models analyzing same problem), external validity (comparing model results to real-world results), and predictive validity (comparing model results with prospectively observed events). The last two are the strongest form of validation. Each section of this paper contains a number of recommendations that were iterated among the authors, as well as the wider modeling task force jointly set up by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making.

Individualized guidelines: the potential for increasing quality and reducing costs.

BACKGROUND: Current guidelines focus on a particular risk factor and specify criteria for categorizing persons into a small number of treatment groups. OBJECTIVE: To compare current guidelines with individualized guidelines (that use readily available characteristics from each person to calculate the risk reduction expected from treatment and to identify persons for treatment in ranked order of decreasing expected benefit), in the context of blood pressure management. DESIGN: Analysis of person-specific, longitudinal data. SETTING: The ARIC (Atherosclerosis Risk in Communities) Study. PARTICIPANTS: Persons aged 45 to 64 years without preexisting cardiovascular disease who currently do not receive antihypertensive treatment. INTERVENTION: Treatment according to the criteria of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 guidelines); individualized guidelines, or treatment in decreasing order of expected benefit; and random care, or treatment of persons selected at random. MEASUREMENTS: Number of myocardial infarctions (MIs) and strokes and medical costs. RESULTS: Compared with treating people according to random care, individualized guidelines could prevent the same number of MIs and strokes as JNC 7 guidelines at savings that are 67% greater than using JNC 7 guidelines, or it could prevent 43% more MIs and strokes for the same cost as treatment according to JNC 7 guidelines. The superiority of individualized guidelines was not sensitive to a wide range of assumptions about costs, treatment effectiveness, level of risk for cardiovascular disease in the population, or effects on workflow. The degree of superiority was sensitive to the accuracy of the method used to rank patients and to its span (the proportion of the population for whom all of the outcomes of interest can be calculated). LIMITATIONS: Specific results apply to the effects of blood pressure management on MI and stroke in the ARIC Study population. The methods for calculating individual benefits require quantitative evidence about the relationships among risk factors, long-term outcomes, and treatment effects. CONCLUSION: Use of individualized guidelines can help to increase the quality and reduce the cost of care.

Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis.

BACKGROUND: No clinical trials have assessed the effects or cost-effectiveness of sequential screening strategies to detect new cases of type 2 diabetes. We used a mathematical model to estimate the cost-effectiveness of several screening strategies. METHODS: We used person-specific data from a representative sample of the US population to create a simulated population of 325,000 people aged 30 years without diabetes. We used the Archimedes model to compare eight simulated screening strategies for type 2 diabetes with a no-screening control strategy. Strategies differed in terms of age at initiation and frequency of screening. Once diagnosed, diabetes treatment was simulated in a standard manner. We calculated the effects of each strategy on the incidence of type 2 diabetes, myocardial infarction, stroke, and microvascular complications in addition to quality of life, costs, and cost per quality-adjusted life-year (QALY). FINDINGS: Compared with no screening, all simulated screening strategies reduced the incidence of myocardial infarction (3-9 events prevented per 1000 people screened) and diabetes-related microvascular complications (3-9 events prevented per 1000 people), and increased the number of QALYs (93-194 undiscounted QALYs) added over 50 years. Most strategies prevented a significant number of simulated deaths (2-5 events per 1000 people). There was little or no effect of screening on incidence of stroke (0-1 event prevented per 1000 people). Five screening strategies had costs per QALY of about US$10,500 or less, whereas costs were much higher for screening started at 45 years of age and repeated every year ($15,509), screening started at 60 years of age and repeated every 3 years ($25,738), or a maximum screening strategy (screening started at 30 years of age and repeated every 6 months; $40,778). Several strategies differed substantially in the number of QALYs gained. Costs per QALY were sensitive to the disutility assigned to the state of having diabetes diagnosed with or without symptoms. INTERPRETATION: In the US population, screening for type 2 diabetes is cost effective when started between the ages of 30 years and 45 years, with screening repeated every 3-5 years. FUNDING: Novo Nordisk, Bayer HealthCare, [corrected] and Pfizer.

Effect of smoking cessation advice on cardiovascular disease.

Performance measures and guidelines encourage physicians to advise smokers to quit. The effect of these efforts on the morbidity, mortality, and cost of cardiovascular disease is not known. This article analyzes the effects of offering smoking cessation advice in the US population. The Archimedes model is used to simulate several clinical trials in which basic advice and medication advice are offered and to calculate the rates of myocardial infarctions, congestive heart disease deaths, strokes, life years, quality-adjusted life years (QALYs), costs, and cost/ QALY. The simulated population is a representative sample of the US population drawn from the Third National Health and Nutrition Survey conducted just before the performance measures and guidelines were introduced. The results show that offering basic advice and medication advice can prevent about 13% and 19% of myocardial infarctions and strokes, respectively. The 30-year cost/QALY is approximately $3000 less than the base-case assumptions and less than $10 000 under pessimistic assumptions.

Relationship of insulin resistance and related metabolic variables to coronary artery disease: a mathematical analysis.

OBJECTIVE: People with diabetes have an increased risk of coronary artery disease (CAD). An unanswered question is what portion of CAD can be attributed to insulin resistance, related metabolic variables, and other known CAD risk factors. RESEARCH DESIGN AND METHODS: The Archimedes model was used to estimate the proportion of myocardial infarctions that would be prevented by maintaining insulin resistance and other risk factors at healthy levels. Person-specific data from the National Health and Nutrition Examination Survey 1998-2004 were used to create a simulated population representative of young adults in the U.S. This population was then entered into a series of simulated clinical trials designed to explore the effects of each risk factor. Each trial had a control arm (all risk factors were allowed to progress without interventions) and a treatment arm (a risk factor was held to its value in young healthy adults). The trials continued for 60 years. The effects of these hypothetical "cures" of each risk factor provide estimates of their impact on CAD. RESULTS: In young adults, preventing insulin resistance would prevent approximately 42% of myocardial infarctions. The next most important determinant of CAD is systolic hypertension, prevention of which would reduce myocardial infarctions by approximately 36%. Following systolic blood pressure, the most important determinants are HDL cholesterol (31%), BMI (21%), LDL cholesterol (16%), triglycerides (10%), fasting plasma glucose and smoking (both approximately 9%), and family history (4%). CONCLUSIONS: Insulin resistance is likely the most important single cause of CAD. A better understanding of its pathogenesis and how it might be prevented or cured could have a profound effect on CAD.

The potential effects of HEDIS performance measures on the quality of care.

We analyzed the potential effects of different levels of performance on eight Health Care Employer Data and Information Set (HEDIS) measures for cardiovascular disease and diabetes during 1995-2005. The measures targeted 3.3 million (25 percent) heart attacks. Improvements in performance to those achieved by the median plan in 2005 imply prevention of 1.9 million myocardial infarctions (MIs, 15 percent), 0.8 million strokes (8 percent), and 0.1 million cases of end-stage renal disease (17 percent). If performance had been 100 percent, 1.4 million more MIs would have been prevented. Control of blood pressure has the largest potential effect on quality at the national level.