Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services.

Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.

Evaluation of Ibuprofen Use on the Immune System Indicators and Force in Disabled Paralympic Powerlifters of Different Sport Levels.

Background: Paralympic powerlifting (PP) training is typically intense and causes fatigue and alterations in the immune system. Objective: To analyze whether IBU would affect performance and the immune system after training in PP. Methodology: 10 athletes at the national level (NL) and 10 at the regional level (RL) participated in the study, where force and blood indicators were evaluated after training. The study took place over three weeks: (1) familiarization and (2 and 3) comparison between recovery methods, with ibuprofen or placebo (IBU vs. PLA), 800 mg. In the evaluation of the force, the peak torque (PT), fatigue index (FI), and blood immune system biomarkers were analyzed. The training consisted of five sets of five repetitions with 80% of one maximum repetition (5 × 5, 80% 1RM) on the bench press. Results: The PT at the national level using IBU was higher than with PLA (p = 0.007, η2p = 0.347), and the FI in the NL was lower with IBU than with PLA (p = 0.002, η2p = 0.635), and when comparing the use of IBU, the NL showed less fatigue than the regional level (p = 0.004, η2p = 0.414). Leukocytes, with the use of IBU in the NL group, were greater than in the RL (p = 0.001, η2p = 0.329). Neutrophils, in the NL with IBU, were greater than in the RL with IBU and PLA (p = 0.025, η2p = 0.444). Lymphocytes, in NL with IBU were lower than in RL with IBU and PLA (p = 0.001, η2p = 0.491). Monocytes, in the NL with IBU and PLA, were lower than in the RL with IBU (p = 0.049, η2p = 0.344). For hemoglobin, hematocrit, and erythrocyte, the NL with IBU and PLA were higher than the RL with IBU and PLA (p < 0.05). Ammonia, with the use of IBU in the NL, obtained values higher than in the RL (p = 0.007), and with the use of PLA, the NL was higher than the RL (p = 0.038, η2p = 0.570). Conclusion: The training level tends to influence the immune system and, combined with the use of the IBU, it tends to improve recovery and the immune system.

BALANCE Dietary Index in Patients with Heart Failure, and Its Adherence in Sergipe, Brazil.

BACKGROUND: "The effective treatment of Heart Failure (HF) involves care with food intake. Recently, the Ministry of Health created the Brazilian Cardioprotective Diet and its dietary index, BALANCE, which assesses adherence to the standard's recommendations". METHODS: This observational prospective study is part of the Congestive Heart Failure Registry (VICTIM-CHF) of Aracaju/SE. Observations and data collection took place from April 2018 to February 2021. Sociodemographic and clinical aspects and food consumption were evaluated. Food intake was determined using the food frequency questionnaire. Foods were categorized using the BALANCE dietary index into green, yellow, blue and red food groups. The BALANCE dietary index was obtained using median and interquartile ranges, scores of the Mann-Whitney U test, and associations between clinical variables and the index, through linear regression. RESULTS: Participants included 240 patients with HF (61.12 ± 1.06 years), who were assisted by the Unified Health System (67.5%). Individuals with a partner showed greater adherence to the green food group recommendations (0.09; 0.00-0.17). The lowest adherence to recommendations regarding the blue food group was observed in individuals with excess weight, who had a higher consumption of foods rich in animal protein (0.54; 0.38-0.78). As for the red food group (ultra-processed foods) the highest adherence was observed by patients with diabetes mellitus (0.41; 0.05-0.77). The greatest adherence to the yellow food group, and a higher score, was observed in patients with the smallest left ventricular systolic diameter (LVSD). CONCLUSIONS: Being married was directly associated with the consumption of foods in the green group, while being overweight and having diabetes were inversely associated with adherence to the blue and red food groups, respectively. Greater adherence to the yellow food group recommendations was inversely associated with less change in the DSFVE.

Assessment of Dynamic Knee Valgus between Lateral Step-Down Test and Running in Female Runners with and without Patellofemoral Pain Using Two-Dimensional Video Analysis.

Dynamic knee valgus (DKV) is a frontal plane knee kinematic alteration that has been associated with patellofemoral pain (PFP) in female runners. DKV is commonly assessed in clinical practice by measuring frontal plane knee projection angle (FPPA) during squat tests. However, it remains unclear whether the DKV observed in these tests is similar to or correlates with that observed during running in female runners. The aims of this cross-sectional study were to correlate and compare DKV, by measuring FPPA values, in a lateral step-down (LSD) squat test and running in female runners with and without PFP. A two-dimensional (2D) video analysis of the LSD test and running was carried out for 21 asymptomatic female runners and 17 PFP female runners in order to determine FPPA values. A Pearson correlation test and a factorial ANOVA with Bonferroni post hoc correction were used for statistical analysis. The FPPAs recorded in the LSD test were significantly higher than those recorded during running in the asymptomatic (16.32° ± 5.38 vs. 4.02° ± 3.26, p < 0.01) and PFP groups (17.54° ± 7.25 vs. 4.64° ± 3.62, p < 0.01). No significant differences were found in FPPA values between asymptomatic and PFP runners during the LSD test (16.32° ± 5.38 vs. 17.54° ± 7.25, p = 0.55) and running (4.02° ± 3.26 vs. 4.64° ± 3.62, p = 0.58). There was a small (r < 0.3) and non-significant (p > 0.05) correlation in FPPAs between the LSD test and running in both groups. According to our results, DKV was not similar during the LSD test and running, and there was no significant correlation in FPPA values between the LSD test and running in both groups. Therefore, clinicians and therapists should be aware of these findings when using the LSD test in clinical practice to evaluate DKV in female runners with or without PFP.

Food Patterns of Hospitalized Patients with Heart Failure and Their Relationship with Demographic, Economic and Clinical Factors in Sergipe, Brazil.

Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)" of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System­SUS (67.5%). Three dietary patterns were identified, labeled "traditional" (typical foods of the Brazilian northeastern population added to ultra-processed foods), "Mediterranean" (foods recommended by the Mediterranean diet) and "dual" (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the "traditional" pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The "Mediterranean" was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The "dual" diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the "traditional" pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the "dual" pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.

Evaluation of Training with Elastic Bands on Strength and Fatigue Indicators in Paralympic Powerlifting.

BACKGROUND: Variable resistance training has recently become a component of strength and conditioning programs. OBJECTIVE: This randomized counterbalanced cross-over study aimed to investigate the use of elastic bands (EB) and the traditional method (TRAD) and force indicators in a training session. METHODS: 12 Paralympic athletes (age: 28.60 ± 7.60 years) participated in this three-week study. In the first week, the participants were familiarized with EB and TRAD and were tested for maximal repetition (1-RM). The research occurred in weeks 2 and 3, which included the pre-post training, during which the following measures were extracted: maximum isometric force (MIF), the peak torque (PT), rate of force development (RFD), fatigue index (FI), and time to MIF (Time). The athletes performed two tests, EB and TRAD, separated by a one-week interval. RESULTS: Significant differences were found between the pre- and post-test for 1RM (p = 0.018, η2p = 0.412), MIF (p = 0.011, η2p = 0.415), PT (p = 0.012, η2p = 0.413), and RFD (p = 0.0002, η2p = 0.761). With the use of EB, there was a difference in RFD between TRAD before and EB after (p = 0.016, η2p = 0.761). There were significant differences in the before and after for FI between TRAD and EB (p < 0.001) and for Time (p < 0.001), indicating that training with the use of elastic bands promotes overload, characterized by increased fatigue and decreased strength. CONCLUSIONS: Training with EB did not decrease 1RM, PT, MIF or RFD, however, there was an increase in fatigue and time to reach MIF when compared to the method with fixed resistance.

Effects of Ibuprofen Use on Lymphocyte Count and Oxidative Stress in Elite Paralympic Powerlifting.

BACKGROUND: Paralympic Powerlifting (PP) training tends to promote fatigue and oxidative stress. OBJECTIVE: To analyze the effects of ibuprofen use on performance and oxidative stress in post-training PP athletes. METHODOLOGY: Ten national level PP athletes (age: 27.13 ± 5.57) were analyzed for oxidative stress in post-training. The study was carried out in three weeks, (1) familiarization and (2 and 3) evaluated the recovery with the use of a placebo (PLA) and ibuprofen (IBU), 800 mg. The Peak Torque (PT), Torque Development Rate (TDR), Fatigue Index (FI), reactive substances to thiobarbituric acid (TBARS) and sulfhydryl groups (SH) were evaluated. The training consisted of five sets of five repetitions (80-90%) 1-Repetition Maximum (1-RM) in the bench press. RESULTS: The IBU showed a higher PT (24 and 48 h, p = 0.04, ɳ2 p = 0.39), a lower FI (24 h, p = 0.01, ɳ2p = 0.74) and an increased lymphocyte count (p < 0.001; ɳ2p = 4.36). There was no change in oxidative stress. CONCLUSIONS: The use of IBU provided improvements in strength and did not protect against oxidative stress.

Bariatric Surgery: Late Outcomes in Patients Who Reduced Comorbidities at Early Follow-Up.

Backgroundand Objectives: In severe obesity, a relevant weight loss can promote the reduction of comorbidities, such as systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM2). Bariatric surgery (BS) has been an essential resource in the therapy of this disease with a short-term reduction of cardiometabolic risk (CR). This study aimed to evaluate the reduction of factors associated with the CR in patients undergoing BS at a 5-year follow-up. Materials and Methods: This is a longitudinal, retrospective study carried out with patients undergoing BS by the Brazilian Public Healthcare System (PHS). Anthropometric and clinical parameters related to the CR (DM2, dyslipidemia, and SAH), quantified by the Assessment of Obesity-Related Comorbidities (AORC) score, were evaluated at the following moments: admission and preoperative and postoperative returns (3 months, 6 months, 1 to 5 years). Results: The sample had a mean age of 44.69 ± 9.49 years and were predominantly in the age group 20-29 years (34.80%) and women (72.46%). At admission to the service, 42.3% had DM2, 50.7% dyslipidemia, and 78.9% SAH. Regarding BS, the gastric bypass technique was used in 92.86% of the sample, and the waiting time for the procedure was 28.3 ± 24.4 months. In the pre- and postoperative period of 3 months, there was a significant reduction in the frequency of DM2 (p < 0.003), dyslipidemia (p < 0.000), and SAH (p < 0.000). However, at postoperative follow-up from 6 months to 5 years, there was no significant reduction in the comorbidities studied. After five years, 35.7% had total remission of DM2 and 2.9% partial remission of DM2, 44.2% had control and remission of dyslipidemia, and 19.6% of SAH (AORC score ≤ 2 for the comorbidities). Conclusion: BS promoted a reduction of the CR in the first three months after BS in severely obese PHS users.

Are Strength Indicators and Skin Temperature Affected by the Type of Warm-Up in Paralympic Powerlifting Athletes?

(1) Background: the present study aimed to evaluate the effect of different types of warm-ups on the strength and skin temperature of Paralympic powerlifting athletes. (2) Methods: the participants were 15 male Paralympic powerlifting athletes. The effects of three different types of warm-up (without warm-up (WW), traditional warm-up (TW), or stretching warm-up (SW)) were analyzed on static and dynamic strength tests as well as in the skin temperature, which was monitored by thermal imaging. (3) Results: no differences in the dynamic and static indicators of the force were shown in relation to the different types of warm-ups. No significant differences were found in relation to peak torque (p = 0.055, F = 4.560, η2p = 0.246 medium effect), and one-repetition maximum (p = 0.139, F = 3.191, η2p = 0.186, medium effect) between the different types of warm-ups. In the thermographic analysis, there was a significant difference only in the pectoral muscle clavicular portion between the TW (33.04 ± 0.71 °C) and the WW (32.51 ± 0.74 °C) (p = 0.038). The TW method also presented slightly higher values than the SW and WW in the pectoral muscles sternal portion and the deltoid anterior portion, but with p-value > 0.05. (4) Conclusions: the types of warm-ups studied do not seem to interfere with the performance of Paralympic Powerlifting athletes. However, the thermal images showed that traditional warm-up best meets the objectives expected for this preparation phase.

Static and Dynamic Strength Indicators in Paralympic Power-Lifters with and without Spinal Cord Injury.

BACKGROUND: In Paralympic powerlifting (PP), athletes with and without spinal cord injury (SCI) compete in the same category. Athletes with SCI may be at a disadvantage in relation to the production of muscle strength and the execution of motor techniques. OBJECTIVE: To analyze the indicators force, dynamic and static, at different intensities, on performance in athletes with and without SCI. METHODS: The sample was composed of two groups of PP athletes: SCI (30.57 ± 4.20 years) and other deficiencies (OD; 25.67 ± 4.52 years). Athletes performed a test of maximum isometric force (MIF), time to MIF (Time), rate of force development (RFD), impulse, variability and fatigue index (FI), dynamic tests Mean Propulsive Velocity (MPV), Maximum Velocity (Vmax) and Power. RESULTS: There were differences in the SCI in relation to OD, 50% 1RM (p < 0.05), in relation to MPV and Vmax. There were no differences in the static force indicators. Regarding EMG, there were differences between the SCI triceps in relation to the previous deltoid (p = 0.012). CONCLUSION: We concluded that the static and dynamic strength indicators are similar in Paralympic powerlifting athletes with spinal cord injury and other disabilities.

Corrigendum: Anxiety and Emotional Intelligence: Comparisons Between Combat Sports, Gender and Levels Using the Trait Meta-Mood Scale and the Inventory of Situations and Anxiety Response.

[This corrects the article DOI: 10.3389/fpsyg.2020.00130.].

Anxiety and Emotional Intelligence: Comparisons Between Combat Sports, Gender and Levels Using the Trait Meta-Mood Scale and the Inventory of Situations and Anxiety Response.

The present study compared emotional intelligence and anxiety between six combat sports of lower, intermediate and high-level female and male athletes. The sample was composed by 444 athletes (age: 24.7 ± 8.8 years, body mass: 72.4 ± 12.1 kg, height: 1.82 ± 0.3 m, and practice time: 13.1 ± 7.4 years) separated by sex (male n = 273, female n = 171) from different combat sports (jiu-jitsu n = 142, judo n = 137, karate n = 57, kendo n = 63, taekwondo n = 25, and freestyle wrestling n = 20) of three levels (high-level n = 57, intermediate n = 137 and low-level n = 142). Inventory of situations and anxiety response (ISRA) provided an independent evaluation for the three systems: cognitive, motor and physiological, as well as a total with four factors of analysis (anxiety before the evaluation, interpersonal, phobic and before habitual, and daily situations). Trait Meta-Mood Scale (TMMS-24) verified emotional intelligence scales. Descriptive results are demonstrated by percentage or median (first quartile Q1; third quartile Q3), Kruskal-Wallis and Mann-Whitney tests were conducted to compare groups, p ≤ 0.05. The main results demonstrated 10% more total anxiety for wrestling and judo compared to the other groups (p ≤ 0.05). Female athletes showed 15% more anxiety than men, while emotional attention demonstrated 10% better results for women. Significant differences were observed between high- versus low-level athletes in the total anxiety with 85 (44; 143) versus 122 (69; 186) of ISRA index and emotional repair with 30 (25; 34) versus 27 (22; 32) of TMMS-24 index. Emotional intelligence seems to be higher in female and in higher level, while anxiety appears to be prevalent in judo and wrestling, low-level and in female athletes. These outcomes provide support for the hypothesis that emotional abilities are an important contributor to emotional intelligence, particularly differentiating high level athletes than other levels. Results can be incorporated into strategies for reducing anxiety and improving emotional intelligence, considering particularities of gender and level groups.