Las personas trans e intersexuales en el deporte competitivo español: tres casos / The Transsexual and Intersex People in Spanish Competitive Sport: Three Cases

La concepción cultural del deporte como una actividad predominantemente masculina ha dificultado la participación de algunos grupos sociales como mujeres, personas trans o intersexuales. El carácter sexuado del deporte se apoya en las diferencias fisiológicas entre mujeres y hombres, y una supuesta desventaja de las mujeres. Por ello, se establecen pruebas de sexo para las mujeres y el acceso de las personas trans e intersexuales se ve obstaculizado. En este estudio reconstruimos, a partir de las normativas y el contexto socio-histórico internacional, la evolución de la participación de personas trans e intersexuales en el deporte competitivo contemporáneo. Asimismo, se profundiza en la aplicación y gestión de dichas normas en el contexto español, apoyado en tres casos de deportistas trans e intersexuales españoles. La discriminación y humillación que han sufrido estas personas obliga a mantener una visión crítica de las políticas deportivas creadas hasta la actualidad

The cultural conception of sport as a predominantly male activity has hindered the participation of some social groups such as women, transsexual or intersex people. The sexed nature of sport is based on physiological differences between women and men, and a supposed women disadvantage. Thus, sex controls are established for women and then trans and intersex people's access to sport is hampered. In this study we reconstruct, based on the regulations and the international socio-historical context, the evolution of the participation of transsexual and intersex people in contemporary competitive sport. Likewise, the application and management of these norms in the Spanish context is deepened, supported by three cases of Spanish transsexual and intersex athletes. The discrimination and humiliation suffered by these persons enforce to maintain a critical vision of the sports policies hitherto created

Development and validation of the Barriers to Physical Activity and Sport Questionnaire for lesbian, gay, bisexual, transgender and queer/questioning persons.

OBJECTIVE: The objective of the study was to develop the Barriers to Physical Activity and Sport Questionnaire for lesbian, gay, bisexual, transgender and queer/questioning (BPASQ-LGBTQ+ [encompassing all spectrums of sexuality and gender]) persons (LGBT), which measures barriers using a socio-ecological model, and to validate it through exploratory and confirmatory factor analysis. STUDY DESIGN: Validation study. METHODS: First, content validity was achieved by (a) developing a bank of items, (b) discussing the adequacy of the items in a committee of experts and classifying the selected ones under three socio-ecological levels (intrapersonal, interpersonal, environmental) and (c) refining wording and relevance of the items after a pilot test. Second, 709 LGBTQ+ persons completed the questionnaire online to establish construct validity, criterion validity and internal consistency. RESULTS: Exploratory factor analysis revealed four underlying factors in the BPASQ-LGBTQ+, thus suggesting that the items initially considered as 'environmental barriers' could be constituting two separate factors based on social interactions or organizational aspects. Competing three- and four-factor models were tested using confirmatory factor analysis. The four-factor structure with two different factors accounting for environmental barriers obtained better values in all fit indices. Cronbach's alpha ranged from 0.745 to 0.813. Participants engaging in regular physical activity and sports reported lower scores in all the barriers subscales than their counterparts. CONCLUSION: The BPASQ-LGBTQ+ is valid and reliable to measure barriers to physical activity and sports in LGBTQ+ people across the different socio-ecological levels. It could be especially useful for understanding the complex relationships between these barriers, which is of great relevance for the design and implementation of interventions addressed to encourage physically active lifestyles among LGBTQ+ people.

Propiedades psicométricas de un cuestionario de Teoría de la Conducta Planeada en la actividad física en alumnado universitario con discapacidad / Psychometric properties of a Theory of Planned Behaviour questionnaire in physical activity in university students with disabilities / Propriedades psicométricas de um questionário de Teoria do Comportamento Planejado em atividade física em estudantes universitários com deficiência

El presente trabajo evalúa las propiedades psicométricas de un cuestionario de Teoría de la Conducta Planeada en la actividad física en una muestra de alumnado universitario con discapacidad. El cuestionario fue administrado a 772 universitarios españoles con discapacidad. La estructura factorial se validó mediante análisis factorial confirmatorio, y para valorar la validez de criterio se llevaron a cabo correlaciones de Spearman entre los constructos de la Teoría de la Conducta Planeada y el tiempo dedicado a la actividad física. La fiabilidad se evaluó mediante el coeficiente alfa de Cronbach. Se evaluaron dos modelos, uno de cuatro factores y uno de cinco factores. El modelo de cinco factores fue el que mejores resultados presentó (CFI=,97; RMSEA=,057; IC 90%=,049-,066) (α=0,870). También se encontraron relaciones positivas entre todos los constructos de la Teoría de la Conducta Planeada y el tiempo dedicado a la actividad física. Los resultados muestran que el instrumento desarrollado resulta válido y fiable y sugieren que "Autoeficacia" y "Controlabilidad" deben considerarse dos factores independientes dentro del modelo. En conclusión, el cuestionario que se ofrece puede ser una herramienta útil para avanzar en el estudio de los factores psicosociales que afectan a la práctica de actividad física de las personas con discapacidad

The aim of this study was to assess the psychometric properties of a Theory of Planned Behaviour questionnaire in physical activity in university students with disabilities. The questionnaire was administered to 772 Spanish university students with disabilities. The factorial structure was validated by confirmatory factor analysis and Spearman correlations between the Theory of Planned Behaviour constructs and time devoted to physical activity were calculated to assess criterion validity. Reliability was assessed using Cronbach's alpha coefficient. Two models were assessed, one with four factors and other one with five factors. The model with five factors obtained better results (CFI=,97; RMSEA=,057; IC 90%:,049-,066) (α=0,870). Positive relations between all the constructs of Theory of Planned Behaviour and the time devoted to physical activity were also found. The results show that the instrument developed is valid and reliable and they suggest that "Self-efficacy" and "Controllability" should be considered as two independent factors of the model. In conclusion, the questionnaire could be a useful tool in order to gain knowledge about the psychosocial factors that affect physical activity participation of people with disabilities

O presente trabalho avalia as propriedades psicométricas de um questionário de Teoria do Comportamento Planejado na atividade física em uma amostra de estudantes universitários com deficiência. O questionário foi administrado a 772 estudantes universitários espanhóis com deficiência. A estrutura fatorial foi validada pela análise fatorial de confirmação e para avaliar a validade do critério, as correlações de Spearman foram realizadas entre as construções da Teoria do Comportamento Planejado e o tempo dedicado à atividade física. A confiabilidade foi avaliada usando o coeficiente alfa de Cronbach. Foram avaliados dois modelos, um dos quatro fatores e um dos cinco fatores. O modelo de cinco fatores mostrou os melhores resultados (CFI = 97, RMSEA = 057, IC 90% = 049-, 066) (α = 0,870). Relações positivas também foram encontradas entre todas as construções da Teoria do Comportamento Planejado e o tempo dedicado à atividade física. Os resultados mostram que o instrumento desenvolvido é válido e confiável e sugere que "Auto-eficácia" e "Controlabilidade" sejam considerados dois fatores independentes dentro do modelo. Em conclusão, o questionário oferecido pode ser uma ferramenta útil para avançar no estudo de fatores psicossociais que afetam a atividade física de pessoas com deficiência

Increased arterial stiffness in children with a parental history of hypertension.

The vascular dynamics of children with a parental history of hypertension has not been defined. The purpose of the current study was to determine whether or not these children have different arterial stiffness compared to the offspring of normotensive parents. One hundred healthy, nonobese subjects (ages 10-21 years) were divided into two groups of 50. Group A included the offspring of hypertensive patients and group B the offspring of normotensive parents. The variables studied were body surface area, blood pressure, and systolic and diastolic diameters of the aortic and carotid arteries as well as maximum velocity flow of these vessels. Carotid and aortic stiffness were calculated. Children and adolescents with a parental history of hypertension had higher carotid stiffness and smaller carotid diameters. These differences continued to be significant when correcting for body surface area. A higher blood pressure and a greater body surface area were also found.

Complex angioplasty and stenting of a saphenous bypass graft using the percutaneous radial approach. Report of a case.

A severely diseased aortocoronary venous by-pass graft is reported. A successful angioplasty plus stenting was performed, via right radial artery, without using a guiding-catheter.

El médico y la industria farmacéutica

El médico ecuatoriano desconoce la realidad en que se desenvuelve la industria farmaceútica, en nustro país. En los últimos años, ha existido una gran preocupación en cuanto a las normas de información farmacéutica, en relación con la promoción de medicamentos. Incluyendo la intervención de los representantes farmacéuticos o visitadores a médicos.

Vascular dynamics in isolated systolic arterial hypertension.

With a growing elderly population, the incidence of isolated systolic hypertension (ISH) has increased. This study characterizes dynamic vascular changes that occur with advanced age and with ISH. Fifty-five healthy individuals and seven with ISH were distributed in seven age groups from the second to the seventh decade. An index of aortic stiffness (delta P/delta V) was derived using a mercury sphygmomanometer to obtain pulse pressure, and ultrasonographic measurements were used to estimate aortic volumes applying the "cylinder formula." The mathematic derivation of this formula is explained in detail. Pulse pressure showed no significant change with age, but showed a significant increase with ISH. A decrease in volume change from systole to diastole was found with advanced age. Normotensive subjects aged 65 +/- 2 years had a 2.6-fold increase in aortic stiffness compared with young individuals. Elderly patients with ISH had a 7-fold increase in aortic stiffness compared with Group 1 (15 +/- 2 years) (p < 0.001) and a 2.7-fold increase compared with Group 6 (normotensive subjects aged 65 +/- 2 years). A strong correlation between systolic pressure and arterial stiffness was observed (r = 0.953) (p < 0.001). The proposed stiffness index was compared with the one described by Hirai, obtaining a high correlation, that is, r = 0.989 (p < 0.001). When compared with Stefanadis' index of distensibility, our index showed a correlation of r = 0.932 (p < 0.003). It is concluded that while systolic pressure is a main determinant of arterial stiffness, the delta P/delta V is a more sensitive method to estimate dynamic changes in elastic arteries such as the aorta.

Structural and dynamic changes in the elastic arteries due to arterial hypertension and hypercholesterolemia.

Five groups of 20 patients each were studied to analyze the vascular dynamics and structure of the elastic arteries. Group I consisted of healthy young individuals (27 +/- 4 years); Group II of healthy adults (46 +/- 9 years); Group III of normotensive hypercholesterolemic adults (45 +/- 12 years and serum cholesterol > 239 mg/dl); Group IV of hypertensive normocholesterolemic adults (56 +/- 13 years); and Group V of hypertensive hypercholesterolemic adults (56 +/- 9 years). The differential arterial pressure was estimated and divided by the volume change (delta P/delta V) of the aorta and the carotid and brachial arteries. The volume change was calculated using the "cylinder formula", measuring the radius from the ultrasonographic vessel image and assigning the cylinder a height of 1 cm. The A/E index of the Doppler transmitral spectrum and the maximum velocity flow using Doppler in the above arteries were calculated. The presence of carotid atherosclerosis was observed and given an arbitrary scoring grade of 0, 1, or 2. A higher arterial and ventricular stiffness was found in the hypertensive patients regardless of the presence of hypercholesterolemia. A higher fall in Doppler velocity and an increase in atherosclerosis lesions were found in Group V. Based on the results of this study, it was concluded that vascular and left ventricular stiffness have a close relationship with arterial hypertension but not with hypercholesterolemia. The hypercholesterolemic patients had a higher prevalence of carotid atherosclerosis and a higher scoring grade of severity.

[Thrombolysis and beta-block in acute myocardial infarct. Their effects on left ventricular function]. / Trombolisis y betabloqueo en el infarto agudo del miocardio. Efectos sobre la función ventricular izquierda.

The effects of metoprolol or streptokinase or the combination of both drugs on left ventricular function and the rescue of the jeopardized myocardium in patients with acute myocardial infarction (AMI) were compared. Thirty-seven patients with AMI were allocated in 3 different groups: 19 received 15 mg of metoprolol i.v. in 15 minutes, 7 were treated with 1.5 million IU i.v. of streptokinase and 11 more received both drugs. The following variables were studied at control and one and twenty-four hours after treatment; blood pressure, heart rate, "double product", systolic time intervals, diastolic time and the sum of ST-segment elevation and the sum of the R wave in the EKG. Blood pressure, heart rate and "double product" decreased in the groups treated with metoprolol. The pre-ejection time/ejection time index did not change in any group. The diastolic time increased with metoprolol and the sum of ST-segment elevation was more reduced with the combined treatment. Also in this group, the sum of R wave did not decrease as it happened in the other 2 groups. It is concluded that the combination of streptokinase and metoprolol was more effective in the rescue of jeopardized myocardium than metoprolol or streptokinase administered alone.

Efficacy and tolerability of amlodipine in patients with mild-to-moderate hypertension.

Twenty-one subjects with mild or moderate systemic hypertension were treated for 12 weeks with amlodipine, a new calcium antagonist of the dihydropyridine group. Initial amlodipine dose was 5 mg once daily, but the dose could be increased after four or eight weeks to 10 mg once daily if diastolic blood pressure was not less than or equal to 90 mmHg (12.0 kPa). At the end of the study, a substantial reduction of systolic blood pressure (20 mmHg-2.7 kPa-from baseline) and diastolic blood pressure (14 mmHg-1.9 kPa-from baseline) was observed. Statistically significant changes in systolic and diastolic blood pressure were produced after four weeks of treatment. There were no statistically significant changes in heart rate throughout the study. Six patients with mild and five patients with moderate hypertension became normotensive after amlodipine treatment (64%). Two with mild hypertension finished the trial without change in hypertensive status, and four with initially moderate hypertension changed to mild at the end of the study. Only one patient dropped out due to an adverse reaction, two adverse events were rated severe, but did not require discontinuation. Overall impressions of efficacy were excellent or good in two-thirds of cases and poor in 10%; overall impressions of toleration were excellent or good in 71% of cases and poor in 10%. It is concluded that amlodipine is useful and well tolerated in patients with mild or moderate hypertension.