Payment perception in the emergency department: The mediating role of perceived quality of healthcare and patient satisfaction.

The aim of this research is to identify the main factors associated with patients' payment perception and the effects of these factors on payment perception. Patients admitted between January and December 2016 at an emergency department of a public hospital in Lisbon, Portugal, were included in this study, with a representative sample size of 382 patients. A 5% margin of error and a 95% confidence interval were used, and all the data were collected between May and November 2017. To test the mediation models, stepwise multiple linear regression analysis was used. The effect of doctors on payment perception through satisfaction and through perceived quality of healthcare (PQHC) is explained by 3% and 4% of the variation, respectively, with statistically significant results (P < .01). Moreover, the effect of privacy and meeting expectations on payment perception through PQHC is explained by 4% and 4% of the variation, with statistically significant results (P < .01). Doctors play a crucial role in understanding the patients' payment perception (with direct and indirect effects). Mediators, in turn, strengthen this effect, in which the contribution of PQHC is more significant than that of satisfaction.

Moderating effects of psychological factors and frequency of experiences in the emergency department: The role of perceived quality of healthcare.

The aim of this study is to identify the main moderators in the relationship between antecedents/predictors (doctors, privacy, accessibility, and availability, perceived waiting time to be called back by the doctor after the examinations and/or tests) and the perceived quality of healthcare (PQHC) in the emergency department (ED). Patients admitted to the ED of a public hospital in Lisbon, Portugal, between January and December 2016 were included in this study, with a representative sample size of 382 patients. A 5% margin of error and a 95% confidence interval were used, and all data were collected between May and November 2017. We used a stepwise multiple linear regression analysis to test the moderation models. We identified 3 main moderators with different moderating roles between the antecedents (predictors) and PQHC: level of life satisfaction, level of happiness, and frequency of ED experiences. Overall satisfaction with doctors is more likely to influence the PQHC among patients with lower levels of life satisfaction. Moreover, privacy and perceived waiting time to be called back by the doctor after an examination and/or test are more likely to influence the PQHC among patients with lower levels of life satisfaction and happiness. Finally, accessibility and availability are more likely to influence the PQHC among patients with more frequent ED experiences. Thus, knowing the moderating effects of psychological factors and the frequency of ED experiences may help to better understand the relationship between PQHC and certain predictors.

Psychometric Assessment of the Physicians' Job Demands and Resources Scale.

Job demands and resources have been consistently associated with the burnout syndrome in physicians, however the literature points to a lack of robust measures to assess these job characteristics across various medical specialties. This study aimed to develop a theoretically and empirically grounded physician-specific job demands and resources self-report measure - the Physicians' Job Demands and Resources Scale. Relevant dimensions of physicians' job demands and resources were identified, corresponding measurement items were generated and pre-tested, and the factor structure of the resulting 44 items was tested with a sample of 9,176 Portuguese physicians. The results of EFAs and CFAs with two random split samples provided consistent evidence of a nine-factor structure with 38 of the 44 items. Importantly, the nine-factor structure is consistent with the dimensions identified in the literature. The paper discusses the theoretical and practical impacts of the scale.

Local ecological knowledge of fishers from southern and southeastern Brazil about the franciscana dolphin Pontoporia blainvillei: Strategies for conservation.

This study compares local ecological knowledge (LEK) of fishers from the Southwest Atlantic Ocean (SWAO), Brazil, related to the franciscana dolphin (Pontoporia blainvillei). We conducted 330 ethnographic interviews in ten fishing communities in southern and southeastern Brazil between 2012 and 2018. Boolean or Classic Logic was used to identify 95 fishers who were able to recognize the franciscana dolphin accordingly to the taxonomic entity P. blainvillei: 23 in northern Espírito Santo state, one in southern Espírito Santo, 20 in northern Rio de Janeiro state, and 51 in northern Paraná state. Among these 95 fishers, 87.4% (n = 83) reported incidental captures in fishing nets. Among these, 52 (54.7%) did not know any solution to this problem. Interviews revealed that the fishers usually discard carcasses in the sea after fat and muscle tissue are removed so that they can be used as bait for shark fishing or as food. In Southeastern Brazil, fishers LEK related to their ability to identify franciscana dolphin varied from 'no identification' and 'extremely low identification' to 'partial' and 'good identification,' while in southern Brazil, fishers mainly presented a 'good identification' of the dolphins. We propose comanagement actions to conserve the franciscana dolphin in the SWAO.

First metal and metalloid study assessment for the Black Triggerfish Melichthys niger (Bloch, 1786): Baseline data from a pristine South Atlantic oceanic island.

Metal and metalloid concentrations in Black Triggerfish, Melichthys niger (Tetraodontiformes, Balistidae), and sediments from Trindade Island, an isolated, pristine, and understudied environment in the Southwestern Atlantic Ocean were determined. Several elements were detected in sediment, including Rare Earth Elements (REE). Hg and the REE Nd were, however, not detected. Elements determined in triggerfish are indicative of systemic circulation and the presence of toxic elements indicates an exposure source. No significant associations were detected between elements in fish organs and total length, suggesting no bioaccumulation with age, nor between organs and sediment, indicating probable dietary origin. Biliary excretion indicated a local chronic source of As and Cd and non-quantifiable REE elimination. Hg concentrations were over thresholds that affect fish biochemistry processes. These baseline data are valuable concerning elemental contamination in remote oceanic islands, with the potential to be applied to future biomonitoring efforts and conservation measures for reef ecosystems worldwide.

Effect of High-Intensity Interval Training on Exercise Capacity, Blood Pressure, and Autonomic Responses in Patients With Hypertension: A Systematic Review and Meta-analysis.

CONTEXT: Despite the well-known positive effects of exercise in hypertensive patients, the best mode of exercise is still under discussion. OBJECTIVE: A systematic review of the literature, synthesizing data on the effects of high-intensity interval training (HIIT) on peak oxygen consumption (VO2 peak), blood pressure (BP), cardiac autonomic modulation, and resting heart rate (HR) in patients with hypertension. DATA SOURCES: MEDLINE (via PubMed), CENTRAL, PEDro database, and SciELO (from the earliest date available to December 31, 2020). STUDY SELECTION: Randomized controlled trials (RCTs) that evaluated the effects of HIIT in hypertensive patients. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 2. DATA EXTRACTION: Mean differences (MDs) with a 95% CI were calculated, and heterogeneity was assessed using the I2 test. RESULTS: Nine RCTs encompassing 569 patients met the eligibility criteria and were included in the systematic review. Five trials compared supervised HIIT with moderate-intensity continuous training (MICT) and a control; 1 trial compared HIIT with MICT, and 3 compared HIIT with a control. In comparison with MICT, HIIT improved VO2 peak MD (3.3 mL.kg-1.min-1; 95% CI, 1.4-5.3; N = 130). In comparison with controls, HIIT improved VO2 peak MD (4.4 mL.kg-1.min-1; 95% CI, 2.5-6.2; N = 162). CONCLUSION: Despite the low quality of the evidence, HIIT is superior to MICT in improving VO2 peak in patients with hypertension. HIIT effectively improved VO2 peak, BP, and resting HR when compared with controls. HIIT appears to be safe only when performed in a supervised manner for stage 1 hypertension patients without associated risk factors.

Capoeira: hypothesis on health rehabilitation and quality-of-life maintenance.

OBJECTIVE: The aim of this work was to present hypotheses supporting capoeira as an activity aimed at health rehabilitation and maintenance of quality of life. METHODS: Capoeira players (n=245), residing in Brazil and abroad, were evaluated for quality of life (physical, social, psychological, and environmental domains from WHOQOL-bref). The capoeira players' quality of life scores were compared to normative values and reference values in martial arts. Besides, studies involving capoeira (Medline/Embase/Cinahl/SportDiscus) were also reviewed for health-related hypotheses, describing population, intervention, comparator, and outcome. RESULTS: There are hypotheses on capoeira improving health through (1) body composition, addressed by two studies investigating waist circumference, bone, and muscle mass; (2) functional capacity, investigated by three studies considering performance variables; (3) metabolism, in two studies demonstrating triglycerides and blood glucose reduction, and an enhancement of anaerobic glycolysis; and (4) cardiovascular parameters, addressed by two studies highlighting an increase in maximal oxygen consumption, heart rate, and rate of pressure product reduction, as well as an increase in parasympathetic activity at rest. The sample of this study had higher quality of life scores when compared to normative values for Brazilians, similar quality of life when it comes to social relationships, higher quality of life in the psychological and environmental domains, and lower quality of life in the physical domain when compared to practitioners of other combat sports/martial arts. CONCLUSION: An analysis of the impacts of capoeira resulted in hypotheses on the rehabilitation of players' biological health. Although the individuals were evaluated within the pandemic period, their quality of life domains were similar or superior to normative or reference values found by studies from before the pandemic.

Capoeira: hypothesis on health rehabilitation and quality-of-life maintenance

SUMMARY OBJECTIVE: The aim of this work was to present hypotheses supporting capoeira as an activity aimed at health rehabilitation and maintenance of quality of life. METHODS: Capoeira players (n=245), residing in Brazil and abroad, were evaluated for quality of life (physical, social, psychological, and environmental domains from WHOQOL-bref). The capoeira players' quality of life scores were compared to normative values and reference values in martial arts. Besides, studies involving capoeira (Medline/Embase/Cinahl/SportDiscus) were also reviewed for health-related hypotheses, describing population, intervention, comparator, and outcome. RESULTS: There are hypotheses on capoeira improving health through (1) body composition, addressed by two studies investigating waist circumference, bone, and muscle mass; (2) functional capacity, investigated by three studies considering performance variables; (3) metabolism, in two studies demonstrating triglycerides and blood glucose reduction, and an enhancement of anaerobic glycolysis; and (4) cardiovascular parameters, addressed by two studies highlighting an increase in maximal oxygen consumption, heart rate, and rate of pressure product reduction, as well as an increase in parasympathetic activity at rest. The sample of this study had higher quality of life scores when compared to normative values for Brazilians, similar quality of life when it comes to social relationships, higher quality of life in the psychological and environmental domains, and lower quality of life in the physical domain when compared to practitioners of other combat sports/martial arts. CONCLUSION: An analysis of the impacts of capoeira resulted in hypotheses on the rehabilitation of players' biological health. Although the individuals were evaluated within the pandemic period, their quality of life domains were similar or superior to normative or reference values found by studies from before the pandemic.

Bio-Strings: A Relational Database Data-Type for Dealing with Large Biosequences.

DNA sequencers output a large set of very long biological data strings that we should persist in databases rather than basic text file systems. Many different data models and database management systems (DBMS) may deal with both storage and efficiency issues regarding genomic datasets. Specifically, there is a need for handling strings with variable sizes while keeping their biological meaning. Relational database management systems (RDBMS) provide several data types that could be further explored for the genomics context. Besides, they enforce integrity, consistency, and enable good abstractions for more conventional data. We propose the relational text data type to represent and manipulate biological sequences and their derivatives. We present a logical schema for representing the core biological information, which may be inferred from a given biological conceptual data schema and the corresponding function manipulations. We implement and evaluate these stored functions into an actual RDBMS for both efficacy and efficiency. We show that it is possible to enforce basic and complex requirements for the genomic domain. We claim that the well-established relational text data type in RDBMS may appropriately handle the representation and persistency of biological sequences. We base our approach on the idea of domain-specific abstract data types that can store data with semantically defined functions while hiding those details from non-technical end-users.

Detraining period of the PILATES method on functional capacity of elderly women with type 2 diabetes: A randomized clinical trial.

INTRODUCTION: The aim of this study was to verify the effects of a 4-week detraining period on the functional capacity of elderly women with type-2 diabetes (T2D) after 12 weeks of a PILATES training program. METHODS: Twenty-two individuals with T2D were randomly allocated into two groups: CONTROL (n = 11; 67.5 ± 6.3 years; 154.7 ± 6.1 cm; 73.5 ± 6.1 kg; calorie intake: 1487.5 ± 360.6 kcal/day) and PILATES (n = 11; 65.5 ± 5.5 years; 155.0 ± 4.5 cm; 66.2 ± 5.4 kg; calorie intake: 1289.3 ± 385.0 kcal/day). The PILATES group participated at a 12-week PILATES program at moderate intensity, 3x/week with each session lasting 60-min. The functional capacity was evaluated in the baseline (PRE), after 12-weeks (POST) and 4-week detraining period (4W_DT). The general index of functional capacity (GIFC) was calculated for all participants. RESULTS: In the PILATES group there was a reduction in performance (increased test time) for the GIFC after 4W_DT in relation to POST (p < 0.05), however, GIFC showing maintenance of performance gain in relation to the PRE (p > 0.05) (PRE: 36.0 ± 5.5 s vs. POST: 27.2 ± 4.0 s vs. 4W_DT: 29.0 ± 4.2 s). The CONTROL group had worse performance than the GIFC POST (35.3 ± 4.6 s) and 4W_DT (35.4 ± 4.6 s) when compared to the PILATES group (F = 106.967; np2 = 0.842; p < 0.001). CONCLUSION: A period of 4W_DT was not able to reduce the functional gains of elderly women with T2D after 12 weeks of PILATES training. These results have a practical application for training professionals, enabling better control and planning of training interruptions on the PILATES method for elderly women with T2D.

Pilates training reduces blood pressure in older women with type 2 diabetes: A randomized controlled trial.

INTRODUCTION: The study investigated the effect of 12 weeks of pilates training on the hemodynamic responses of older women with type-2 diabetes (T2D). METHODS: 22 individuals with T2D were randomly allocated into two groups: CONTROL (n = 11; 67.5 ± 6.3 years; 154.7 ± 6.1 cm; 73.5 ± 6.1 kg; calorie intake: 1487.5 ± 360.6 kcal/day) and PILATES (n = 11; 65.5 ± 5.5 years; 155.0 ± 4.5 cm; 66.2 ± 5.4 kg; calorie intake: 1289.3 ± 385.0 kcal/day). The PILATES group executed a 12-week PILATES training program at moderate intensity, 3x/week with each session lasting 60-min. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and postprandial blood glucose were assessed at four timepoints: i) baseline; ii) 4th week; iii) 8th week; and iv) 12th week (s) of intervention. Two-way ANOVA for repeated measures and the Pearson's correlation coefficient were adopted. The alpha level was set at 0.05. RESULTS: A time∗group interaction effect was found for SBP (F = 4.206; η2 = 0.17; p = 0.02) and DBP (F = 2.624; η2 = 0.12; p = 0.05) with significant reductions (mmHg) in the 4ths and 8ths in the PILATES (PILATES SBP baseline: 134.9 ± 27.6; 4ths: 112.4 ± 15.7; 8ths: 115.8 ± 18.3; 12ths: 124.3 ± 19.1 vs. CONTROL SBP baseline: 126.5 ± 15.7; 4ths: 126.3 ± 16.2; 8ths: 124.5 ± 13.1; 12ths: 126.3 ± 21.4 | PILATES DBP baseline: 72.9 ± 11.3; 4ths: 65.1 ± 12.2; 8ths: 65.8 ± 12.2; 12ths: 67.6 ± 7.5 vs. CONTROL DBP baseline: 74.6 ± 12.0; 4ths: 73.9 ± 11.5; 8ths: 75.3 ± 11.9; 12ths: 74.5 ± 9.2). CONCLUSION: Four and eight weeks of PILATES training promotes reduction in the SBP and DBP of older women with T2D. The exercises performed in this study were mainly body weight exercises and required a few auxiliary materials, which turns this method of training accessible.

Mulheres brasileiras que praticam com maior frequência o treinamento resistido apresentam menores escores de ansiedade e depressão / Brazilian women who practice resistance training more frequently present lower anxiety and depression scores

O objetivo deste estudo foi verificar a associação entre o treinamento resistido (TR) e variáveis relacionadas com escores de ansiedade e depressão em mulheres brasileiras. Participaram do estudo 154 mulheres praticantes de TR (40,9±8,6 anos; 61,7±9,9 kg; 160,0±5,0 cm) e 113 mulheres não praticantes de exercício físico (Controle) (39,0±8,0 anos; 64,2±11,2 kg; 160,0±6,0 cm). As participantes responderam à Hospital Anxiety and Depression Scale e questões sociodemográficas relacionadas ao exercício físico. Diferenças estatísticas ocorreram entre os grupos em relação à ansiedade (TR: 0,75±0,48 vs. Controle: 1,07±0,57; P<0,001) e depressão (TR: 0,84±0,34 vs. Controle: 1,02±0,40; P<0,001). A frequência semanal de TR foi preditora de ansiedade [ß=-0,165; F(1,138)=6,39; P=0,05] e depressão [ß=-0,213; F(1,138)=6,46; P=0,01]. Conclui-se que mulheres brasileiras que praticam TR apresentam menores escores de ansiedade e depressão quando comparadas à não praticantes de exercício físico. Além disso, maior frequência semanal de TR prediz menores escores de ansiedade e depressão nesta população.

The aim was to verify the association between resistance training (RT) and related variables with anxiety and depression scores in Brazilian women. One hundred and fifty-four women practitioners of RT (40.9±8.6 years; 61.7±9.9 kg; 160.0±5.0 cm) and 113 non-practitioners (Control) participated in the study. Participants answered the Hospital Anxiety and Depression Scale and sociodemographic questions related to physical exercise. Statistical differences between groups occurred for anxiety (RT: 0.75±0.48 vs. Control: 1.07±0.57; P<0.001) and depression (RT: 0.84±0.34 vs. Control: 1.02±0.40; P<0.001). Weekly RT frequency significantly predicted anxiety [ß=-0.165; F(1.138)=6.39; P=0.05] and depression [ß=-0.213; F(1.138)=6.46; P=0.01]. We concluded that Brazilian women who practice RT presented lower anxiety and depression scores when compared to non-practitioners. In addition, a higher weekly frequency of RT predicted lower depression and anxiety scores in this population.

Perceptual Responses and Future Exercise Intentions of Individuals With Systemic Arterial Hypertension.

To analyze the perceptual responses and future intentions (FI) to engage in continuous moderate aerobic exercise (CE) and high-intensity interval exercise (HIIE) of individuals with systemic arterial hypertension (SAH), we had 25 participants with SAH (M age = 48.0, SD = 8.0 years) perform, on different days and in randomized order, 33 minute sessions of CE and 30 minutes of HIIE. Twenty seconds after each 3-minutes of these sessions, we obtained participant responses to Ratings of Perceived Exertion (RPE), the Feeling Scale (FS), the Felt Arousal Scale (FAS), and attentional focus (AF). We assessed their FI to engage in CE and HIIE at the end of each session. We analyzed results using two-way ANOVAs with repeated measures, Spearman correlation coefficients, a simple linear regression, and Wilcoxon test. We found a significant time by session type (CE and HIIE) interaction effect for RPE (p < .001), FAS (p = .002), and AF (p = .004). Participants' FI to engage in HIIE were only significantly correlated with FAS (r = -.424; p = .035) and AF (r = .431; p = .032) responses. FAS responses (ßz = -.455; R2 = .207; p = .022) and AF responses (ßz = .467; R2 = .218; p = .019) predicted FI for engaging in HIIE. There were no significant differences in participants' FI to engage in CE sessions (M = 76.4, SD =22.5%) versus HIIE sessions (M = 71.8, SD = 22.9%; p = .177). Individuals with SAH had more positive perceptions of CE than HIIE, as seen by their greater dissociative AF in the CE sessions. Furthermore, these results supported the application of strategies aimed at manipulating AF in this population, possibly as a tool to increase participants' FI to engage in subsequent physical exercise.

Anaerobic Threshold Determination in Cycle Ergometer From Rating of Perceived Exertion.

ABSTRACT: Santos, GAd, Numata-Filho, ES, Rosa, TdS, Passos Neves, RV, Simões, HG, and Moreira, SR. Anaerobic threshold determination in cycle ergometer from rating of perceived exertion. J Strength Cond Res 36(5): 1277-1281, 2022-The objective of the study was to investigate the validity of the rating of perceived exertion threshold (TRPE) for anaerobic threshold (AT) estimation during an incremental test (IT) on a cycle ergometer. Nineteen physically active and healthy men performed an IT on a cycle ergometer. The intensity corresponding to the AT was considered as the point immediately before the abrupt increase in blood lactate concentration ([La]) in the IT. TRPE was determined in the last intensity corresponding to perceptual response previous the 15 arbitrary units (AU) in the 15-point RPE scale. The heart rate (HR), [La], and RPE were obtained at the end of each stage of the IT. There was no significant difference between workload obtained from the AT (150 [120-150] watts) and TRPE (150 [120-150] watts) (p > 0.05). In addition, there were no differences between HR (AT, 139.5 ± 12.7 b·min-1 vs. TRPE, 141.9 ± 14.6 b·min-1, p > 0.05) and [La] (AT, 3.1 [2.8-3.2] mM vs. TRPE, 3.1 [2.9-3.7] mM, p > 0.05). There was a strong correlation between the intensities in AT and TRPE during the IT (r = 0.88). A substantial reliability (intraclass correlation coefficient = 0.84 [0.64-0.94 confidence interval 95%]) was evidenced, as well as a substantial agreement between the AT and TRPE intensities (Pc = 0.84), as confirmed by the Bland-Altman plot (-4.7 [-34.2/24.7]). TRPE was a predictor of the AT (ß = 1.146, R = 0.770, SEE = 15.070, p < 0.01). It can be concluded that TRPE is valid for AT estimation during an IT on a cycle ergometer.

Respostas agudas da glicose sanguínea no segundo dia da recuperação do exercício resistido de moderada vs. alta intensidade em mulheres com diabetes tipo 2 / Acute blood glucose responses on the second day of recovery from moderate vs. high intensity resistance exercise in women with type 2 diabetes

O exercício resistido (ER) pode reduzir a glicose no sangue em pessoas com diabetes tipo 2 (DM2). No entanto, é necessária maior clareza quanto à intensidade do ER e ao tempo necessário para essa resposta aguda. Portanto, o objetivo deste estudo foi comparar as respostas agudas de glicose no sangue no segundo dia de recuperação do ER moderada versus de alta intensidade em mulheres com DM2. Doze mulheres com DM2 (55,2 ± 4,0 anos; 70,1 ± 11,4 kg; e 155,7 ± 3,3 cm) realizaram duas sessões experimentais com sete dias de intervalo em ordem aleatória. Para a sessão 1: ER40% do teste de uma repetição máxima (1RM) e sessão 2: ER80%1RM, com 16 e 8 repetições para cada série, respectivamente, em 7 exercícios com 3 circuitos durante 40min. A glicemia foi monitorada por 35h (primeiro dia: 24h e segundo dia: 11h) a cada 5 minutos após cada sessão experimental pelo Sistema de Monitoramento Contínuo de Glicose (modelo Guardian REAL-Time). O teste t de Student não mostrou diferença significativa na glicemia do segundo dia (11h) após as sessões de ER40%1RM vs. RE80%1RM [respectivamente, 161,3 ± 62,3 mg.dL-1 vs. 157,2 ± 41,9 mg.dL-1; t (11) = 0,259; p = 0,800]. A ANOVA two-way para medidas repetidas mostrou que as respostas de glicose no sangue a cada hora durante a recuperação no segundo dia não mostraram diferenças significativas entre as sessões de ER [F (1,731; 19,039) = 0,688; p = 0,734]. Concluímos que as respostas glicêmicas agudas no segundo dia da recuperação do ER de intensidade moderada e alta não diferiram entre as mulheres com DM2.

Resistance exercise (RE) can lower blood glucose in people with type 2 diabetes (T2D). However, greater clarity is needed regarding the RE intensity and time required for this acute response. Therefore, the aim of this study was to compare acute blood glucose responses on the second day of recovery from moderate vs. high-intensity RE in women with T2D. Twelve women with T2D (55.2 ± 4.0 years; 70.1 ± 11.4 kg; and 155.7 ± 3.3 cm) performed two experimental sessions seven days apart in a randomized order. For session 1: RE40% of one-repetition maximum test (1RM) and session 2: RE80%1RM, with 16 and 8 repetitions for each set, respectively, in 7 exercises with 3 circuits during 40min. Blood glucose was monitored for over 35h (first day: 24h and second day: 11h) every 5 minutes after each experimental session by the Continuous Glucose Monitoring System (Guardian REAL-Time model). Student's t-test showed no significant difference in blood glucose on the second day (11h) after RE40%1RM vs. RE80%1RM sessions [respectively, 161.3 ± 62.3 mg.dL-1 vs. 157.2 ± 41.9 mg.dL-1; t (11) = 0.259; p = 0.800]. Two-way ANOVA for repeated measures showed that blood glucose responses every hour during recovery on the second day showed no significant differences between RE sessions [F (1.731, 19.039) = 0.688; p = 0.734]. We concluded that the acute blood glucose responses on the second day of moderate and high intensity RE did not differ among women with T2D.

Understanding Complaints in the Emergency Department.

The aim of this research is to identify the main determinants of patients' complaints and potential mediators and moderators in this regard. This research shows that complaints can result from a complex set of processes involving direct, mediating, and moderating effects. Interventions aimed at reducing patients' complaints should consider specific patient groups and experiences.

Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial

ABSTRACT BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial.

BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

Predictors of Burnout Among Physicians: Evidence From a National Study in Portugal.

The aims of this research on burnout among physicians were threefold, (1) to characterize the burnout symptoms' prevalence among Portuguese physicians, (2) to test the hypothesis that organizational demands and resources add, on top of other factors, to the explanatory level of burnout; and (3) to explore the predictors of organizational demands and resources. Data collection was conducted online at the national level in Portugal, with 9,176 complete replies and a response rate of 21%. Predictors stemming from theoretical models of an intra-individual, occupational, organizational, and socio-psychological nature were measured using an online/paper survey. Results were analyzed through a significantly modified version of the Maslach Burnout Inventory (MBI) after transformations to address the fit of this measure in this sample. Results show that 66% of physicians have high levels of emotional exhaustion, 33% high levels of depersonalization, and 39% high levels of decrease of personal accomplishment. Moreover, a first set of hierarchical multiple regression models with burnout symptoms reveals that organizational resources, demands of the relationship with the patients and of work schedule are consistently important predictors of emotional exhaustion and depersonalization on top of other theoretically relevant predictors. A second set of regression models with the organizational-level variables shows that, aside from organizational variables, other context variables, like procedural justice and teamwork, have the most substantial predictive value. These results highlight the importance of recognizing physicians' burnout as a phenomenon that is predicted by a wide variety of factors, but also the importance of attending to the particular role of circumstancial factors that may be addressed in future interventions.

Anthropometric profile and functional performance of capoeira competitors in the world games / Perfil antropométrico y desempeño funcional de los competidores de capoeira en los juegos mundiales

SUMMARY: This study aimed to characterize the anthropometric profile and functional performance of elite competitors in different categories in the world championship of the ABADÁ-Capoeira School. Fifty high level male athletes were divided according to their weight categories, being: light category (VIOLA: ≤ 76.9 kg; n = 15); intermediate category (MEDIO: > 77.0 kg until ≤ 85.9 kg; n = 25) and heavy category (GUNGA: ≥ 86.0 kg; n = 10). Two evaluation batteries were performed: 1) anthropometry and somatotype determination; 2) physical performance in tests of push-up, sit-up, sit-and-reach, quadrant jump test, squat jump (SJ), and counter movement jump (CMJ). The "endo-mesomorph" classification predominated in the three categories. There was a difference in the quadrant jump test between VIOLA and GUNGA subgroups (F[2.47] = 4.299; p = 0.019). Endomorphism had a negative correlation (p < 0.01) with the performance in the sit-up (r = -0.51), push-up (r = -0.39), SJ (r = -0.45), and CMJ (r = -0.49). Male elite competitors at the international level, regardless the weight category, have a predominance of the mesomorphic component of the somatotype. Moreover, all capoeira athletes were classified as excellent for the sit-and-reach, sit-up, and push-up, and the latter were positively correlated with mesomorphism. However, endomorphism was inversely associated with the sit-up, push-up, SJ, and CMJ. In this way, the present study assists coaches in the formulation of appropriate training programs aiming the development of an ideal physical composition, which will be associated with high-level performance in capoeira.

RESUMEN: Este estudio tuvo como objetivo caracterizar el perfil antropométrico y el desempeño funcional de los competidores de élite en diferentes categorías en el campeonato mundial de la Escuela de Capoeira ABADÁ. Cincuenta deportistas masculinos de alto nivel se dividieron según sus categorías de peso: categoría ligera (VIOLA: ≤ 76,9 kg; n = 15); categoría intermedia (MEDIO: > 77,0 kg hasta ≤ 85,9 kg; n = 25) y categoría pesada (GUNGA: ≥ 86,0 kg; n = 10). Se realizaron dos baterías de evaluación: 1) antropometría y determinación del somatotipo; 2) rendimiento físico en pruebas de flexiones, abdominales, sentadillas y estiramientos, prueba de salto en cuadrante, salto en cuclillas y salto con contramovimiento. La clasificación "endo-mesomorfo" predominó en las tres categorías. Hubo una diferencia en la prueba de salto de cuadrante entre los subgrupos VIOLA y GUNGA (F [2,47] = 4,299; p = 0,019). El endomorfismo tuvo una correlación negativa (p <0.01) con el desempeño en los abdominales (r = - 0,51), lagartijas (r = -0,39), SJ (r = -0,45) y CMJ (r = - 0,49). Los competidores de élite masculinos a nivel internacional, indepen- dientemente de la categoría de peso, tienen predominio del componente mesomórfico del somatotipo. Además, todos los atletas de capoeira fueron clasificados como excelentes para sit-and-reach, sit-up y push-up, y estos últimos se correlacionaron positivamente con el MESO. Sin embargo, el ENDO se asoció inversamente con los abdominales, lagartijas, SJ y CMJ. De esta manera, el presente estudio ayuda a los entrenadores en la formulación de programas de entrenamiento adecuados que apunten al desarrollo de una composición física ideal, que estará asociada con un rendimiento de alto nivel en la capoeira.