Resultados de la implementación de una guía de recomendaciones en el cuidado de las personas con ostomías digestivas / Results in the Application of a Recommendation Guide for the Care of People with Digestive Ostomy / Resultados da implementação de diretrizes de recomendações no cuidado de pessoas com ostomias digestivas

Introducción. La instauración de una ostomía digestiva tiene una importante repercusión física y emocional en las personas. El objetivo de este estudio es analizar la adherencia de las enfermeras a las buenas prácticas en el manejo de las ostomías, la disminución de complicaciones y la adquisición de destrezas de los pacientes en su propio autocuidado tras la implementación de la Guía de Buenas Prácticas de la asociación de enfermeras de Ontario. Metodología. Estudio cuasiexperimental prospectivo en una unidad de cirugía digestiva desde 2017 hasta 2022. La intervención ha consistido en la implementación de las recomendaciones de cuidados de una Guía de Buenas Prácticas, analizando variables de proceso y de resultados en la salud a lo largo del proceso. Resultados. Se han encontrado diferencias significativas (p<0.05) en las variables de adherencia: educación sanitaria preoperatoria, marcaje del estoma, evaluación integral posoperatoria y educación sanitaria posoperatoria. No se han encontrado diferencias significativas en las variables de complicaciones del estoma (del 37.5% al 27.8%), ni en las complicaciones de la piel periestomal (del 12.5% al 10.2%). Sí se han encontrado diferencias en la variable de adquisición de destrezas del paciente en su autocuidado (del 44.44% al 98%). Discusión. Implantar recomendaciones de buenas prácticas mejora la calidad de los cuidados y disminuye las complicaciones. Conclusiones. La implementación de la guía ha aumentado la adherencia de las enfermeras a las buenas prácticas basadas en la evidencia y ha mejorado la adquisición de destrezas de los pacientes en su autocuidado, disminuyendo las complicaciones (aunque sin significación). Palabras clave: Estomía; Autocuidado; Guía de Práctica Clínica; Enfermería Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud

Introduction. The establishment of a digestive ostomy has an essential physical and emotional repercussion. This study aims to analyze nurses' adherence to the good practice of management in ostomy, the decrease of complications, and the acquisition of patients' ability in self-care after implementing the Ontario Nurses' Good Practices guide. Methodology. A quasi-experimental prospective study in a digestive surgery unit from 2017 to 2022. The intervention consists of implementing the recommendations made in the Good Practices Guide and analyzing variables of process and health throughout the process. Results. Significative differences have been found (p<0.05) in the adherence variables: preoperatory sanitary education, marking of stoma, post-operatory integral evaluation, and sanitary post-operatory education. The investigators did not find significant differences in the variable of stoma complications (from 37.5% to 27.8%) or the peristoma skin complications (from 12.5% to 10.2%). A difference in the acquisition of abilities of the patient self-care was found (from 44.4% to 98%). Discussion. To make good practice recommendations improves the quality of the care and reduces complications. Conclusions. Implementing the guide has increased the nurses' adherence to the good practices based on the evidence and the acquisition of abilities in the patient's self-care, decreasing the complications (even though it didn't show significance). Keywords: Ostomy; Self Care; Practice Guideline; Evidence-Based Nursing; Outcome Assessment, Health Care

Introdução. A realização de uma ostomia digestiva tem um importante impacto físico e emocional nas pessoas. O objetivo deste estudo é analisar a adesão das enfermeiras às boas práticas no manejo de ostomias, a redução de complicações e a aquisição de habilidades dos pacientes no seu próprio autocuidado após a implementação das diretrizes de boas práticas dos Associação de Enfermeiras de Ontário. Metodologia. Estudo prospectivo quase-experimental numa unidade de cirurgia digestiva de 2017 a 2022. A intervenção consistiu na implementação das recomendações de cuidados das Diretrizes de Boas Práticas, analisando variáveis de processo e resultados de saúde ao longo do processo. Resultados. Foram encontradas diferenças significativas (p<0.05) nas variáveis de adesão: educação em saúde préoperatória, marcação do estoma, avaliação pós-operatória abrangente e educação em saúde pós-operatória. Não foram encontradas diferenças significativas nas variáveis de complicações do estoma (de 37.5% para 27.8%), nem nas complicações da pele periestomal (de 12.5% para 10.2%). Foram encontradas diferenças na variável aquisição de habilidades de autocuidado pelo paciente (de 44.44% para 98%). Discussão. A implementação de recomendações de boas práticas melhora a qualidade dos cuidados e reduz complicações. Conclusões. A implementação das diretrizes aumentou a adesão das enfermeiras às boas práticas baseadas em evidências e melhorou a aquisição de habilidades de autocuidado pelos pacientes, diminuindo complicações (embora não significativamente). Palavras-chave: Estomia; Autocuidado; Guia de Prática Clínica; Enfermagem Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde

Quantitative Analysis of the Texas Music Educators Association (TMEA) All-State Choral Audition Music.

INTRODUCTION: Young voices experience a multitude of physiological and hormonal changes that can impact vocal production. Singing an ensemble voice part that demands more than an adolescent laryngeal structure can readily support may be detrimental to vocal health and enjoyment. OBJECTIVES: This study analyzes the musical range, tessitura, cycle dose, short-term recovery dose, and time dose of choral selections for the popular and competitive Texas Music Educators Association (TMEA) All-State competition as a means of informing successful audition and rehearsal practices. METHODS: An expanded model based on previous work by Stefan Thurmer, Ingo Titze, and John Nix is used to analyze the TMEA All-State Large-School, Treble, and Tenor-Bass choral audition music. Each vocal part's pitches are subdivided by the piece's smallest common rhythmic duration and converted to hertz for equal weighting. Quartile analysis is used to define tessitura as the inclusive range between the first and third quartiles. RESULTS: This method reveals the musical range, tessitura, cycle dose, short-term recovery dose, and time dose in an objective manner that can be compared with individual voices for best fit using similar individual metrics and the voice range profile. DISCUSSION: Vocal characteristics that individual singers should possess to successfully navigate the exacting All-State audition and rehearsal process are described based on data interpretation. Teachers and conductors can prepare their students for success by evaluating these factors ahead of time and assigning parts based on information gleaned from these methods.

Multimodal intervention for preventing peripheral intravenous catheter failure in adults (PREBACP): a multicentre, cluster-randomised, controlled trial.

BACKGROUND: 2 billion peripheral intravenous catheters (PIVC) are inserted into inpatients worldwide each year. Almost one in two PIVCs fail before completion of intravenous therapy. We aimed to determine the efficacy and costs of a multimodal intervention to reduce PIVC failure among hospitalised patients. METHODS: PREBACP was a cluster-randomised, controlled trial done at seven public hospitals in Spain. Clusters (hospital wards) had at least 70% permanent staff and data were collected from patients aged 18 years and older with one or more PIVCs at the start of intravenous therapy. Clusters were randomly assigned (1:1) to the multimodal intervention or control group using a centralised, web-based randomisation software, and stratified by type of setting. We concealed randomisation to allocation, without masking patients or professionals to the intervention. An intervention using a multimodal model and dissemination of protocols, education for health-care professionals and patients, and feedback on performance was implemented for 12 months in the intervention group. The control group received usual care. The primary outcome was all-cause PIVC failure at 12 months (phlebitis, extravasation, obstruction, or infections). Subsequently, through an amendment to the protocol approved on July 25, 2021, we included dislodgement as part of PIVC failure. Analysis was by modified intention to treat, which included all randomly assigned hospital wards for whom data on the primary endpoint were available. This trial is registered with the ISRCTN Registry, ISRCTN10438530. FINDINGS: Between Jan 1, 2019, and March 1, 2020, we randomly assigned 22 eligible clusters to receive the multimodal intervention (n=11 clusters; 2196 patients, 2235 PIVCs, and 131 nurses) or usual practice in the control group (n=11 clusters; 2282 patients, 2330 PIVCs, and 138 nurses). At 12 months, the proportion of PIVC failures was lower in the intervention group than in the control group (37·10% [SD 1·32], HR 0·81 [95% CI 0·72 to 0·92] vs 46·49% [2·59], HR 1·23 [1·04 to 1·39]; mean difference -9·39% [95% CI -11·22 to -7·57]; p<0·0001). Per-protocol-prespecified analysis of the primary outcome excluding dislodgement also showed the intervention significantly reduced PIVC failure compared with the control group at 12 months (33·47% [SD 2·98], HR 0·85 [95% CI 0·75 to 0·96] vs 41·06% [4·62], HR 1·18 [1·04 to 1·33]; mean difference -7·59% [95% CI -11·05 to -4·13]; p<0·0001). INTERPRETATION: A multimodal intervention reduced PIVC failure, thereby reducing potentially serious complications for hospitalised patients. The findings of PREBACP enabled a deeper understanding of decision making, knowledge mobilisation, and sense making in routine clinical practice. FUNDING: The College of Nurses of the Balearic Islands. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

AIM: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice. DESIGN: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. METHODS: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. DISCUSSION: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. IMPACT: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España / Social networks in the clinical practice evidence implementation strategy: experience from Hospital Regional Universitario de Málaga, Spain / Redes sociais na estratégia de implementação de evidências na prática clínica: experiência do Hospital Regional Universitario de Málaga, Espanha

Introducción. Twitter se ha convertido en el foro favorito para la comunicación de la atención médica, en cuanto permite a los usuarios publicar y compartir mensajes fácilmente a sus seguidores. En el Hospital Regional Universitario de Málaga (HRUM) se ha recurrido al uso de las redes sociales, particularmente Twitter, para facilitar la implementación y difusión de las recomendaciones de las Guías de Buenas Prácticas (GBP) de la Registered Nurses Association of Ontario (RNAO) en la práctica clínica. El objetivo del presente artículo es describir la estrategia y reflexionar acerca del rol de las redes sociales en las estrategias y los resultados de implantación de recomendaciones de GBP de la RNAO. Temas de reflexión. Siguiendo la metodología del modelo Best Practice Spotlight Organization (BPSO), se ha otorgado un papel protagonista a las enfermeras asistenciales de cada unidad a través de la formación, creación de equipos de implantación y difusión del programa. El uso de nuevos registros y, sobre todo, el uso de las redes sociales, ha obtenido unos resultados excelentes de adherencia de los profesionales al programa tanto a nivel cuantitativo como cualitativo. Conclusiones. El uso de las redes sociales como estrategia de difusión en la implantación de las recomendaciones de las GBP de la RNAO ha conseguido muy buena acogida por parte de los profesionales, pues muestra un alto nivel de participación, y es una herramienta útil como estrategia de difusión. Se necesita más tiempo para monitorizar el uso de las redes sociales y su posible impacto en la implantación de evidencias y la mejora de los resultados de salud de los pacientes y organizaciones de salud. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571

Introduction. Twitter has become the favored forum for communicating health care, since it allows users to publish and share messages with their followers. At Hospital Regional Universitario de Málaga (HRUM), they have used social networks, particularly Twitter, to facilitate implementing and broadcasting the recommendations from the Registered Nurses Association of Ontario's (RNAO) Best Practice Guideline (BPG) for clinical practice. The objective of this paper is to describe the strategy and reflect on the role of social networks on the strategies and results of implementing the RNAO's BPG recommendations. Topics of reflection. In accordance to the methodology of the Best Practice Spotlight Organization (BPSO) model, a leading role has been given to the nurses at each unit through training, creation of implementation teams and broadcasting the program. Using new records and, most of all, social networks, the strategy has obtained excellent results from professionals when it comes to adherence to the program, both quantitatively and qualitatively. Conclusions. The use of social networks as a broadcasting strategy in implementing the RNAO's BPG recommendations has been well received by professionals. The strategy shows high participation levels and is a useful tool as a broadcasting strategy. More time is needed to monitor social network use and its possible impact on generating evidence, as well as the improvement of healthcare organizations and patient's health results. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571

Introdução. O Twitter se tornou o fórum favorito para a comunicação no atendimento médico, pois permite que os usuários publiquem e compartilhem facilmente mensagens para seus seguidores. No Hospital Regional Universitário de Málaga (HRUM), foram utilizadas as redes sociais, particularmente o Twitter, para facilitar a implementação e disseminação das recomendações das Guias de Boas Práticas (GBP) da Registered Nurses Association of Ontario (RNAO) na prática clínica. O objetivo deste artigo é descrever a estratégia e refletir sobre o papel das redes sociais nas estratégias e nos resultados da implementação das recomendações do GBPs da RNAO. Tópicos de reflexão. Seguindo a metodología do modelo Best Practice Spotlight Organization, foi atribuído um papel essencial às enfermeiras de cada unidade por meio de treinamento, criação de equipes de implementação e divulgação do programa. O uso de novos registros e, sobretudo, o uso de redes sociais, obteve excelentes resultados de adesão dos profissionais ao programa, tanto quantitativa quanto qualitativamente. Conclusões. O uso das redes sociais como estratégia de disseminação na implementação das recomendações do GBPs da RNAO alcançou uma boa recepção pelos profissionais, pois mostra um alto nível de participação e é uma ferramenta útil como estratégia de disseminação. É necessário mais tempo para monitorar o uso das redes sociais e seu possível impacto na implementação de evidências e na melhoria dos resultados de saúde de pacientes e organizações de saúde. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571

Nutritional intake and body composition changes in a UCI World Tour cycling team during the Tour of Spain.

The aim of this study was to quantify the food intake of an International Cyclist Union (UCI) World Tour professional cyclist team and to analyse changes in body composition during the Tour of Spain. Nine male professional road cyclists (31.3 ± 3.0 years) volunteered to participate in the study. Nutritional data were collected each day throughout the 3-week Tour by two trained investigators who weighed the food ingested by the cyclists. Mean nutritional intake of the cyclists was as follows: carbohydrate, 12.5 ± 1.8 g/kg/day of body weight (BW) (65.0 ± 5.9%); fat, 1.5 ± 0.5 g/kg/day BW (17.9 ± 5.6%); and protein, 3.3 ± 0.3 g/kg/day BW (17.1 ± 1.6%). Intake of all micronutrients, except for folate, vitamin D and potassium (which were 78.7%, 46% and 84% of Recommended Dietary Allowances (RDA), respectively), exceeded the RDA. Height, weight, skinfolds, circumferences and diameters were taken following the guidelines outlined by the International Society for the Advancement of Kinanthropometry. Body density, body fat percentage, muscle mass, total muscle mass and fat mass of the arms and thighs were calculated. Percentage body fat, fat mass and upper arm fat mass significantly decreased (p < .05) after the Tour independent of the equation method used in the calculations. Total muscle mass remained unchanged. Generally, this sample of cyclists consumed more protein and less fat than the recommended amount and had low weight, BMI and fat mass. It is suggested that sports nutritionists design personalised diets in order to maintain a correct proportion of nutrients as well as controlling possible anthropometrical changes that could affect performance.

Obtaining ready-to-eat blue corn expanded snacks with anthocyanins using an extrusion process and response surface methodology.

Extrusion is an alternative technology for the production of nixtamalized products. The aim of this study was to obtain an expanded nixtamalized snack with whole blue corn and using the extrusion process, to preserve the highest possible total anthocyanin content, intense blue/purple coloration (color b) and the highest expansion index. A central composite experimental design was used. The extrusion process factors were: feed moisture (FM, 15%-23%), calcium hydroxide concentration (CHC, 0%-0.25%) and final extruder temperature (T, 110-150 °C). The chemical and physical properties evaluated in the extrudates were moisture content (MC, %), total anthocyanins (TA, mg·kg(-1)), pH, color (L, a, b) and expansion index (EI). ANOVA and surface response methodology were applied to evaluate the effects of the extrusion factors. FM and T significantly affected the response variables. An optimization step was performed by overlaying three contour plots to predict the best combination region. The extrudates were obtained under the following optimum factors: FM (%) = 16.94, CHC (%) = 0.095 and T (°C) = 141.89. The predicted extrusion processing factors were highly accurate, yielding an expanded nixtamalized snack with 158.87 mg·kg(-1) TA (estimated: 160 mg·kg(-1)), an EI of 3.19 (estimated: 2.66), and color parameter b of -0.44 (estimated: 0.10).

Commercial breakfast cereals available in Mexican markets and their contribution in dietary fiber, ß-glucans and protein quality by rat bioassays.

The beneficial effect of dietary fiber (DF) consumption has long been recognized. The global economy and open market trade policies have increased the availability of food products in Mexican markets, resulting in a wide variety of ready-to-eat commercial breakfast cereals classified as 'high fiber'. This research was aimed to evaluate the total dietary fiber contents, its fractions (soluble and insoluble) and ß-glucan in 13 commercial 'high-fiber' breakfast cereals, as well as to evaluate their protein quality by rat bioassays. Commercial 'high-fiber' breakfast cereals had 7.42-39.82% insoluble dietary fiber, 2.53-12.85% soluble dietary fiber, and 0.45-4.96% ß-glucan. These ready-to-eat commercial 'high-fiber' breakfast cereals differed significantly in their total dietary fiber, their soluble and insoluble DF fractions, and also in their ß-glucan contents. When supplied as experimental diets, in 14-day rat feeding trials, the 'high-fiber' breakfast cereals showed an adverse effect on the % N digestibility but protein utilization, as measured as net protein ratio (NPR), was not significantly affected. The consumption of these commercial breakfast cereals, especially those made of oats as the basic ingredient, is highly recommended, since these products, being a concentrated source of dietary fiber, do not affect their protein quality.

Isolation and partial characterization of three isoamylases of Rhyzopertha dominica F. (Coleoptera: Bostrichidae).

Three isoamylases of Rhyzopertha dominica (termed RdA70, RdA79, and RdA90 according to their relative mobility in gel electrophoresis) were isolated by ammonium sulfate fractionation and hydrophobic interaction chromatography. RdA70 and RdA79 showed an optimal pH of 7.0, whereas for RdA90 the optimal pH was 6.5. The three isoamylases remained stable at 50 degrees C for 1 h, but at 60 degrees C, all lost 50% of their activity in 20 min and were completely inactivated in 1 h. RdA70 and RdA79 were inhibited by albumin extracts from wheat samples varying widely in amylase inhibitory activity; however, RdA90 was highly resistant to inhibition. beta-Mercaptoethanol up to 30 mM increased the activity of the three isoamylases by 2.5-fold. The action pattern of the three isoamylases was typical of endoamylases; however, differences were observed on the hydrolytic efficiency rates measured as V(max)/K(m) ratio on starch, amylopectin, and amylose. The hydrolyzing action of RdA90 on starch and amylopectin (V(max)/K(m)=90.4+/-2.3 and 78.9+/-6.6, respectively) was less efficient than that on amylose (V(max)/K(m)=214+/-23.2). RdA79 efficiently hydrolyzed both amylopectin and amylose (V(max)/K(m)=260.6+/-12.9 and 326.5+/-9.4, respectively). RdA70 hydrolyzed starch and amylose at similar rates (V(max)/K(m)=202.9+/-5.5 and 215.9+/-6.2, respectively), but amylopectin was a poor substrate (V(max)/K(m)=124.2+/-7.4). The overall results suggest that RdA70 and RdA79 appear to belong to a group of saccharifying isoamylases that breaks down long fragments of oligosaccharide chains produced by the hydrolytic action of RdA90. The simultaneous action of the three isoamylases on starch, aside from the high resistance of RdA90 to wheat amylase inhibitors, might allow R. dominica to feed and reproduce successfully on the wheat kernel.

Efecto del sexo de la rata (Sprague Dawley) sobre la digestibilidad y razón neta de proteína en alimentos de distinta calidad proteica / Effect of rat (Sprague Dawley) sex on digestibility and net protein ratio in foods of different protein quality

The effect of grouping by sex Sprague Dawley rats on protein quality evaluation of three foods was studied. Bioassays performed were dry matter digestibility (DMD), apparent and true nitrogen digestibility (AND y TND) and net protein ratio (NPR). Foods of different protein quality used were dry whole milk, texturized soybean and high fiber breakfast cereal obtained from the local market. Casein was used as control. An experimental block design where the blocks were the groups of rats classified as mixed, female and male was used. Data of consumed diet, total feces and weight gain of each rat was recorded every third day. It was concluded that with the exception of the high fiber breakfast cereal, which showed significant differences between males and females in the true nitrogen digestibility parameter, in general grouping by sex did not have a significant effect on dry matter, AND, TND and NPR responses. These results suggest the possibility of using rats from either sex in these protein quality evaluation tests.

La influencia del agrupamiento por sexo de las ratas Sprague Dawley fue evaluada al determinar la calidad proteica en tres alimentos. Los bioensayos realizados fueron digestibilidad de materia seca (DMsec), digestibilidad de nitrógeno aparente y verdadera (DNap y DNver) y razón neta de proteína (NPR). Las muestras empleadas fueron alimentos de distinta calidad proteica: leche en polvo, soya texturizada y cereal, obtenidas del comercio local y caseína como control. Se utilizó un diseño experimental por grupos: mixto, hembras y machos. Se colectaron datos cada tercer día: alimento consumido, el total de heces y el incremento en peso de cada individuo. Se concluye de manera general, que el agrupamiento por sexo de la rata no tiene efecto significativo sobre la respuesta de estos bioensayos evaluados en los alimentos probados, a excepción del cereal que presentó diferencias significativas entre machos y hembras en el parámetro de DNver, sugiriendo que es factible utilizar ratas de diferente sexo en estas evaluaciones de calidad proteica.

Regulation of energy expenditure during prolonged athletic competition.

BACKGROUND: Athletic competitions, such as the Tour de France, demand both momentary bursts of very high power output and the ability to provide high levels of energy expenditure for several weeks. As such, they provide a model of the ability for sustained muscular activity, which is important in terms of how humans are understood, not only as athletes, but also within an evolutionary context. METHODS: Laboratory correlated HR responses were made of elite professional cyclists (N=7) during successive competitions in one of the three grand tours in cycling in successive years, with the intent of evaluating the magnitude and pattern of energy expenditure. HR recordings were normalized into a training impulse (TRIMP) score, summating the intensity and duration of each race, and tracked over the duration of successive tours. RESULTS: Although the day-by-day pattern of HR responses in exercise intensity zones associated with exercise intensities below the first ventilatory threshold, between the first and second ventilatory thresholds, and above the second ventilatory threshold varied in response to the course and competitive situation, the net accumulation of both time in each of the HR zones and TRIMP was remarkably constant from one tour to the next, both within the group at large as well as within individual athletes. The magnitude of accumulation of TRIMP was similar to that of previous reports on elite tour cyclists. CONCLUSIONS: We interpret these results as evidence that humans adopt a pacing strategy designed to optimally distribute energy reserves over the duration of each tour.

Tour de France versus Vuelta a España: which is harder?

PURPOSE: To compare the total exercise loads (intensity x volume) of the Vuelta a España and Tour de France during the last year. METHODS: Seven professional road cyclists (28 +/- 1 yr; [OV0312]O(2max): 74.6 +/- 2.2 mL.kg-1.min-1) who participated in both Tour and Vuelta during the years 1997, 1999, 2000, or 2001 were collected as subjects. They wore a heart rate (HR) telemeter during each stage of the two races, and exercise intensity was divided into three phases according to the reference HR values obtained during a previous ramp cycle-ergometer test: phase I (RCP). Total volume and intensity were integrated as a single variable. The score for volume x intensity in each phase was computed by multiplying the accumulated duration in this phase by a multiplier for this particular phase. The total score for Tour and Vuelta was obtained by summating the results of the three phases. RESULTS: The total loads (volume x intensity) did not significantly differ between the two races (P > 0.05), despite a significantly longer total exercise time of the Tour (P < 0.05) (5552 +/- 176 vs 5086 +/- 290 min). CONCLUSION: The physiological loads imposed on cyclists' bodies do not differ between the Tour and Vuelta, despite the longer duration of daily stages in the former race.

Inverse relationship between VO2max and economy/efficiency in world-class cyclists.

PURPOSE: To determine the relationship that exists between VO2max and cycling economy/efficiency during intense, submaximal exercise in world-class road professional cyclists. METHODS Each of 11 male cyclists (26+/-1 yr (mean +/- SEM); VO2max: 72.0 +/- 1.8 mL x kg(-1) x min(-1)) performed: 1) a ramp test for O2max determination and 2) a constant-load test of 20-min duration at the power output eliciting 80% of subjects' VO2max during the previous ramp test (mean power output of 385 +/- 7 W). Cycling economy (CE) and gross mechanical efficiency (GE) were calculated during the constant-load tests. RESULTS: CE and GE averaged 85.2 +/- 2.3 W x L(-1) x min(-1) and 24.5 +/- 0.7%, respectively. An inverse, significant correlation was found between 1) VO2max (mL x kg(-0.32) x min(-1)) and both CE (r = -0.71; P = 0.01) and GE (-0.72; P = 0.01), and 2) VO2max (mL x kg(-1) x min(-1)) and both CE (r = -0.65; P = 0.03) and GE (-0.64; P = 0.03). CONCLUSIONS: A high CE/GE seems to compensate for a relatively low VO2max in professional cyclists.

Curvilinear VO(2):power output relationship in a ramp test in professional cyclists: possible association with blood hemoglobin concentration.

The purpose of this study was to determine (1) if there exists an additional, nonlinear increase (DeltaVO(2)) in the oxygen uptake observed (VO2 (obs)) at the maximal power output reached during a ramp cycle ergometer test and that expected (VO2 (exp)) from the linear relationship between VO(2) and power output below the lactate threshold (LT) in professional riders, and (2) the relationship between DeltaVO(2) and possible explanatory mechanisms. Each of 12 professional cyclists (25 +/- 1 years; VO(2 max): 71.3 +/- 1.2 ml x kg(-1) x min(-1)) performed a ramp test until exhaustion (power output increases of 25 W x min(-1)) during which several gas-exchange and blood variables were measured (including lactate, HCO(3)(-) and K(+)). VO(2) was linearly related to power output until the LT in all subjects. Afterward, a nonlinear deflection was observed in the VO(2):power output relationship (DeltaVO(2) = 2492 +/- 55 ml x min(-1) and p < 0.05 for VO2 (obs) vs. VO2 (exp)). A significant negative correlation was encountered between DeltaVO(2) and resting hemoglobin levels before the tests (r = 20.61; p < 0.05). In conclusion, professional cyclists exhibit an attenuation of the VO(2) rise above the LT.

Kinetics of VO(2) in professional cyclists.

PURPOSE: To analyze the kinetics of oxygen uptake (VO(2)) in professional road cyclists during a ramp cycle ergometer test and to compare the results with those derived from well-trained amateur cyclists. METHODS: Twelve professional cyclists (P group; 25 +/- 1 yr; maximal power output (W(max)), 508.3 +/- 9.3 watts) and 10 amateur cyclists (A group; 22 +/- 1 y; W(max), 429.9 +/- 8.6 watts) performed a ramp test until exhaustion (power output increases of 25 watts x min(-1)). The regression lines of the VO(2):power output (W) relationship were calculated for the following three phases: phase I (below the lactate threshold (LT)), phase II (between LT and the respiratory compensation point (RCP)), and phase III (above RCP). RESULTS: In group P, the mean slope (Delta VO(2):Delta W) of the VO(2):W relationship decreased significantly (P < 0.01) across the three phases (9.9 +/- 0.1, 8.9 +/- 0.2, and 3.8 +/- 0.6 mL O(2) x watts(-1) x min(-1) for phases I, II, and III, respectively). No significant differences (P > 0.05) were found between phases I and II (P > 0.05) in group A, whereas Delta VO(2):Delta W significantly increased in phase III (P < 0.01), compared with phase II (10.2 +/- 0.3, 9.2 +/- 0.4, and 10.1 +/- 1.1 mL O(2) x watts(-1) x min(-1) in phases I, II, and III, respectively). The mean value of Delta VO(2):Delta W for phase III was significantly lower in group P than in group A (P < 0.01). CONCLUSION: Contrary to the case in amateur riders, the rise in VO(2) in professional cyclists is attenuated at moderate to high workloads. This is possibly an adaptation to the higher demands of their training/competition schedule.

Factores dietéticos, protectores y de riesgo para infección por Helicobacter pylori

La prevalencia del Helicobacter pylori es alta en nuestro medio, hay informes del 90 por ciento en algunas series de personas sanas. Existen controversia con respecto a la vía de transmisión. Hay algunas evidencias que sugieren que la bacteria ingresa por vía oral. Este trabajo trata de identificar las posibles variables ambientales y/o de la dieta que aumentan el riesgo o protegen de esta infección. Se estudiaron 146 pacientes, 65 con Helicobacter positivos y 81 sin la presencia de la bacteria documentadas por histología. A estas pacientes se les aplicó una encuesta de las condiciones ambientales y dietarias del individuo. En los resultados se encontró como factor protector el hervir el agua, mientras el consumo de pescado y alimentos callejeros se constituyeron como un riesgo para adquirir la infección. Este trabajo sugiere que el hervir el agua puede constituir una medida sanitaria para disminuir el riesgo de infección

Presentación de dos casos de neumatosis cistoide intestinal asociado a fístulas rectovesical y sigmoidovesical y hallazgo incidental a la colonoscopia

Se presentan dos casos de neumatosis cistoide intestinal asociados a fistula rectovesical y sigmoidovesical uno de ellos diagnosticado durante la colonoscopia. Revisión de la literatura

Sintesis historica, doctrinal y organizativa de las iglesias evangelicas de Santa Cruz

Contiene: Misiones - Situacion politica y religiosa de Bolivia (1492-1989) - Entrada de los misioneros en Bolivia - Las seis primeras misiones en Bolivia (1895-1920) - Misiones cristianas en Bolivia - La llegada de la mision a Santa Cruz - Lideres preminentes - Organizacion - Doctrina - Instituciones educativas, teologicas y de obra social - Las iglesias evangelicas hasta 1989.