Percepções e ações da equipe multiprofissional em saúde sobre a medicina tradicional indígena / Perceptions and actions of the multi-professional health team on traditional indigenous medicine / Percepciones y acciones del equipo multidisciplinario de salud sobre la medicina tradicional indígena

Objetivo: compreender as percepções e as ações de uma equipe multiprofissional em saúde quanto à prática da medicina tradicional indígena em uma Casa de Atenção à Saúde Indígena. Método: estudo qualitativo descritivo, realizado em uma de Casa de Apoio à Saúde Indígena em um município do Pará, que incluiu oito profissionais de uma equipe multiprofissional. A coleta de dados foi realizada no ano de 2018 e estes foram examinados pelo método da análise de conteúdo. Resultados: inserção e prática do cristianismo; ritos e lideranças xamânicas; e postura da equipe de multidisciplinar foram as categorias elencadas, que apontam os entendimentos e atuações da equipe multiprofissional e da organização espacial da Casa de Saúde do município. Considerações finais: há novos costumes e valores entre as etnias, em virtude da aproximação de grupos religiosos, cujas ações foram registradas e apreendidas pela equipe de trabalhadores em saúde.

Objective: understanding the perceptions and actions of a multi-professional health team regarding the practice of traditional indigenous medicine in an Indigenous Health Care Center. Method: this is a descriptive qualitative study carried out in an Indigenous Health Support Center in a municipality in the state of Pará, which included eight professionals from a multi-professional team. Data was collected in 2018 and examined using the content analysis method. Results: insertion and practice of Christianity; shamanic rites and leadership; and the attitude of the multidisciplinary team were the categories listed, which point to the understandings and actions of the multi-professional team and the spatial organization of the Health Center in the municipality. Final considerations: there are new customs and values among ethnic groups, due to the approach of religious groups, whose actions were recorded and apprehended by the team of health workers.

Objetivo: comprender las percepciones y acciones de un equipo multidisciplinario de salud sobre la práctica de la medicina tradicional indígena en una Casa de Atención para la Salud Indígena. Método: estudio descriptivo cualitativo, realizado en una Casa de Apoyo a la Salud Indígena de un municipio de Pará, que incluyó ocho profesionales de un equipo multidisciplinario. La recolección de datos se realizó en 2018 y los datos fueron sometidos al método de análisis de contenido. Resultados: inserción y práctica del cristianismo; ritos y líderes chamánicos; y actitud del equipo multidisciplinario fueron las categorías enumeradas, que indican la percepción y las acciones del equipo multidisciplinario y la organización espacial de la Casa de Salud del municipio. Consideraciones finales: existen nuevas costumbres y valores entre las etnias, debido a la presencia de grupos religiosos, el equipo de los trabajadores de la salud registró y aprendió las acciones de los indígenas.

Motivation to learn: an international multilevel study on student autonomy and teacher emphasis on content usefulness / Motivación para aprender: un estudio internacional multinivel sobre la autonomía de los estudiantes y el énfasis de los docentes en la utilidad del contenido

En la educación superior, pocos estudios relacionan factores contextuales en la clase, como el énfasis del profesor en la utilidad del contenido y las características motivacionales de los estudiantes. El objetivo fue probar un modelo multinivel sobre la relación entre el énfasis del docente en la utilidad del contenido durante la clase, la autonomía de los estudiantes y, a su vez, la motivación para aprender. Participaron 3033 estudiantes universitarios matriculados de 1º a 4º grado de Ciencias de la Actividad Física y del Deporte, de universidades de España (N = 602), Portugal (N = 469), México (N = 1177), Chile (N = 372), y Brasil (N = 413). Se realizó un modelo de ecuaciones estructurales multinivel, en el que los participantes respondieron preguntas sobre el énfasis del profesor en la utilidad del contenido de la clase, la autonomía y la motivación para aprender. Se hipotetizó que el énfasis del profesor en la utilidad del contenido predecía la autonomía del estudiante que, por su vez, predecía la motivación para aprender. Los resultados, a nivel grupal e individual, indican que el énfasis del docente en la utilidad del contenido predijo la autonomía del estudiante, y la autonomía predijo la motivación para aprender.(AU)

Teacher autonomy support is related to improved student learn-ing. In higher education, few studies relate classroom contextual factors, such as teacher emphasis on content usefulness, and students' motivational characteristics. The aim was to test a multilevel model about the relation between the extent of teachers’ emphasis on the usefulness of class con-tent with student autonomy, and, in turn, on motivation to learn. The par-ticipants were 3033 university students enrolled from 1st to 4th grade of Sciences of the Physical Activity and Sport, from universities in Spain (N = 602), Portugal (N = 469), Mexico (N = 1177), Chile (N = 372), and Brazil (N = 413). A multilevel structural equation model was performed, in which participants answered questions about the teacher's emphasis on the use-fulness of class content, basic psychological need for autonomy, and moti-vation to learn. At the group and individual levels, the hypothesis is that the teacher's emphasis on the usefulness of class content predict the stu-dent autonomy, in turn, student autonomy predicts student motivation to learn. Results found at the group level and at the individual level the strength of teacher emphasis on class content predicted student autonomy; student autonomy predicted student motivation to learn.(AU)

Athlete Identity, Resilience, Satisfaction with Life and Well-Being of Para Badminton Players: A Multinational Survey.

Objective: To explore regional differences (i.e. Europe, Asia and others) in the well-being of para-athletes and its potential psychosocial determinants, including the Athletic Identity Measure Scale (AIMS), the Brief Resilience Scale (BRS) and the Satisfaction with Life Scale (SWLS). Methods: The study was a cross-sectional survey using data from multinational badminton federations. The study participants were athletes registered in the Para Badminton Classification Master List of the Badminton World Federation (BWF). The main study outcome is the WHO Quality of Life-Disability Questionnaire (WHOQOL-DIS). Results: There were 1,385 (aged 36 years old, IQR 18 years old) registrants on the master list. Respondents totaled 170. Only 137 (65% were males) were included in the analysis after excluding those with missing data (Europe 40%, Asia 30%, others 30%). Following the results of factor analysis, the original Athletic Identity Measure Scale (AIMS) was separated into self-identity (SI) and AIMS-modified. SI, AIMS-modified, the BRS and the Satisfaction with Life Scale (SWLS) were all scored above average. The AIMS-modified scores of Europeans were significantly lower than those of other non-Asians (U = 757.000, P < 0.05). BRS was statistically higher among those with acquired disabilities (median: 3.33) compared to those with congenital disabilities (median: 3.0) (U = 1,717.000, Z = -2.711, P < 0.05) and among Europeans (median: 3.3) compared to Asians (median: 3.0) (U = 704.500, P < 0.05). The regression model explained 32% of the variability in quality of life (QOL) with five significant predictors. The SWLS (ß = 0.307, P = 0.01), BRS (ß = 0.269, P = 0.01), full-time employment (ß = 0.191, P = 0.05) and being female (ß = 0.162, P = 0.05) all had a positive effect on QOL, but not the AIMS (-0.228, P = 0.05). Conclusion: The results show that the athletes' resilience, satisfaction with life and identity vary across regions. Furthermore, satisfaction with life, employment and gender were found to be significant predictors of athletes' QOL.

Cereal-based fermented foods as microbiota-directed products for improved child nutrition and health in sub-Saharan Africa.

Several strategies, programs and policies have long been developed and implemented to alleviate child malnutrition in sub-Saharan African countries. However, stunting and wasting still persist at an alarming rate, suggesting that alternative strategies are needed to induce faster progress toward the 2030 SDGs targets of reducing malnutrition. Gut microbiota-directed intervention is now being recognized as an unconventional powerful approach to mitigate malnutrition and improve overall child health. In an African setting, manufactured probiotic and synbiotic foods or supplements may not be successful owing to the non-affordability and high attachment of African populations to their food tradition. This review analyses the potential of indigenous fermented cereal-based products including porridges, doughs, beverages, bread- and yoghurt-like products, to be used as microbiota-directed foods for over 6 months children. The discussion includes relevant strategies to effectively enhance the beneficial effects of these products on gut microbiota composition for improved child health and nutrition in sub-Saharan Africa. Characterization of probiotic features and general safety of food processing in sub-Saharan Africa as well as randomized clinical studies are still lacking to fully ascertain the health effects and suitability of these fermented foods in preventing and treating child malnutrition and diarrhea.

Dependence of Europe's most threatened mammals on movement to adapt to climate change.

Current rates of climate change and gloomy climate projections confront managers and conservation planners with the need to integrate climate change into already complex decision-making processes. Predicting and prioritizing climatically stable areas and the areas likely to facilitate adaptive species' range adjustments are important stages in maximizing conservation outcomes and rationalizing future land management. I determined, for the most threatened European terrestrial mammal species, the spatial adaptive trajectories (SATs) of highest expected persistence up to 2080. I devised simple spatial network indices for evaluation of species in those SATs: total persistence; proportion of SATs that offer in situ adaptation (i.e., stable refugia); number of SATs converging in a site; and relationship between SAT convergence and persistence and protected areas, the Natura 2000 and Emerald networks, and areas of low human disturbance. I compared the performance of high-persistence SATs with a scenario in which each species remained in the areas with the best climatic conditions in the baseline period. The 1000 most persistence SATs for each of the 39 species covered one fifth of Europe. The areas with the largest adaptive potential (i.e., high persistence, stability, and SAT convergence) did not always overlap for all the species. Predominantly, these regions were located in southwestern Europe, Central Europe, and Scandinavia, with some occurrences in Eastern Europe. For most species, persistence in the most climatically suitable areas during the baseline period was lower than within SATs, underscoring their reliance on adaptive movements. Importantly, conservation areas (particularly protected areas) covered only minor fractions of species persistence among SATs, and hubs of spatial climate adaptation (i.e., areas of high SAT convergence) were seriously underrepresented in most conservation areas. These results highlight the need to perform analyses on spatial species' dynamics under climate change.

Los mamíferos más amenazados de Europa y su dependencia del movimiento para adaptarse al cambio climático Resumen La tasa actual del cambio climático y las proyecciones climáticas pesimistas confrontan a los gestores y a los planeadores de la conservación con la necesidad de integrar este cambio a la ya de por sí compleja toma de decisiones. La predicción y priorización de áreas con estabilidad climática y áreas con probabilidad de facilitarles ajustes adaptativos de distribución a las especies son etapas importantes para maximizar los resultados de conservación y racionalizar la gestión futura de las tierras. Determiné las trayectorias espaciales adaptativas (TEA) para la mayoría de los mamíferos terrestres más amenazados de Europa con la persistencia esperada más alta hasta el 2080. Diseñé los siguientes índices de redes espaciales simples para la evaluación de especies en aquellas TEA: persistencia total, proporción de TEA que brindan adaptación in situ (refugios estables), número de TEA que convergen en un sitio y relación entre la convergencia de TEA y la persistencia con las áreas protegidas, las redes Natura 2000 y Emerald y las áreas de poca perturbación humana. Comparé el desempeño de las TEA de gran persistencia con un escenario en el que las especies permanecían dentro de las áreas con las mejores condiciones climáticas en el periodo de línea base. Las mil TEA más persistentes para cada una de las 39 especies cubrieron la quinta parte de Europa. Las áreas con el mayor potencial adaptativo (es decir, gran persistencia, estabilidad y convergencia de TEA) no siempre se traslaparon para todas las especies. Estas regiones predominaron en el suroeste de Europa, Europa Central y Escandinavia, con algunas ocurrencias en el este de Europa. Para la mayoría de las especies, la persistencia de las áreas con el mejor clima posible durante el periodo de línea base fue menor que dentro de las TEA, lo que resalta su dependencia por los movimientos adaptativos. Destaca que las áreas de conservación (en particular las áreas protegidas) cubrieron sólo pequeñas fracciones de la persistencia de las especies entre las TEA y los núcleos de adaptación climática (es decir, las áreas de gran convergencia de TEA) contaban con muy poca representación dentro de la mayoría de las áreas de conservación. Estos resultados enfatizan la necesidad de realizar análisis de las dinámicas espaciales de las especies bajo el cambio climático.

Evaluating the Validity of Tests to Predict Sprint and Change of Direction Speed in Para-Athletes With Brain Impairments.

Maximum running speed is a performance determinant in para-athletics and cerebral palsy football. Sixty international para-athletes with brain impairments completed five activity-limitation tests (standing broad jump, four bounds for distance, split jumps, 10-m speed skip, and running in place) and two criterion tests (40-m sprint and modified agility test). The same three tests (standing broad jump, four bounds for distance, and 10-m speed skip) that correlated with running performance in nondisabled runners (.67 < r < -.82; p < .05; 75% of variance) also correlated in para-athletes with brain impairments (.41 < r < -.62; p < .01; 55% of variance). Standing broad jump, four bounds for distance, split jumps, and running in place also correlated with change-of-direction speed (.43 < r < -.63; p < .01; 58% of variance). Results indicate that methods of classification for para-athletics with nondisabled runners are also valid with para-athletes with brain impairments, and new sport-specific relationships were found for assessing the performance of rapid and short sprints toward different directions, specific of a team para-sport like cerebral palsy football.

The effects of simulated monocular and binocular vision impairment on football penalty kick performance.

Sports performance is relatively robust under high levels of binocular blur. However, the limited research studies investigating monocular impairments has shown it has a larger impact on sport performance. This research study is relevant for classification in sports for athletes with vision impairment (VI), where visual acuity (VA) from the better eye is used during classification. Across two experiments, we aimed to establish the point at which binocular and monocular impairments affected performance in a football penalty kick (PK) through simulating varying severities of degraded VA and contrast sensitivity (CS) in active football players. In experiment one, 25 footballers performed PKs as VA and CS were systematically decreased in both eyes, and in one condition, visual field (VF) was reduced. The most severe VA/CS condition and reduced VF significantly impacted outcome, ball velocity and placement (ball kicked closer to the centre of the goal) (p < 0.05). In experiment two, 29 different footballers performed PKs as VA and CS of only the dominant eye were systematically decreased and in one condition the dominant eye was occluded, and participants viewed their environment through the non-dominant eye (monocular viewing). No differences were observed when assessing monocular impairments influence on outcome, velocity and ball placement. PKs have a high resilience to VI, but binocular impairment has a more immediate effect, suggesting binocular measures should be used in classification processes in football.

The analysis of methylamphetamine and para-hydroxy-methylamphetamine in post-mortem hair samples using liquid chromatography-tandem mass spectrometry.

External contamination is a well-recognized limitation of hair analysis for drugs of abuse like methylamphetamine (MA), and there are no guidelines regarding the analysis of specific metabolites of MA to assist interpretation. We developed an analytical method to detect MA, amphetamine (AMP), and para-hydroxy-methylamphetamine (p-OH-MA) in hair and present their concentrations among a cohort of deceased persons positive for MA in blood (n = 63). Hair samples (≤ 3 cm) were washed with dichloromethane and water prior to extraction using a methanolic micro-pulverization. The reconstituted hair extracts were separated on a UCT Selectra® Aqueous C18 HPLC Column (100 × 2.1 mm, 3 µm) by gradient elution and detected using a Sciex Triple Quad 6500+ system. Validation was satisfactory, and the lower limits of quantitation were 0.01 ng/mg for MA and AMP and 0.001 ng/mg for p-OH-MA. The median hair concentrations of MA, AMP, and p-OH-MA were 13 ng/mg (range = 0.015-49; n = 51), 1.1 ng/mg (range = 0.018-44; n = 60), and 0.020 ng/mg (range = 0.0012-0.38, n = 62), respectively. These concentrations in hair were strongly positively correlated (r = .7202 to .8641, p < .001), suggesting similar modes of incorporation. Moreover, the wash/hair ratios were indicative of external contamination, especially among the soiled group of hair samples. Therefore, further studies are necessary to determine concentrations of p-OH-MA in living MA users and confirm if this metabolite constitutes a potential marker of MA consumption.

Prevalence of therapeutic use exemptions at the Olympic Games and Paralympic Games: an analysis of data from 2016 to 2022.

OBJECTIVES: The objectives of this study are to describe the prevalence of therapeutic use exemptions (TUEs) among athletes competing in four Olympic and four Paralympic games. The secondary objective was to present the prohibited substance and methods classes associated with TUEs. METHODS: Data from the Anti-Doping Administration and Management System were extracted for this cross-sectional observation study. Eight cohorts were created to include athletes with TUEs who competed in the Rio 2016, Pyeongchang 2018, Tokyo 2020 and Beijing 2022 Olympic and Paralympic games. Prevalence of TUEs and proportion of prohibited substance and methods classes were defined as percentages among all athletes competing at each games. RESULTS: 28 583 athletes competed in four editions of the Olympic games. Total prevalence of athletes with TUEs was 0.90% among all competitors. At the four Paralympic games, a total of 9852 athletes competed and the total TUE prevalence was 2.76%. The most frequently observed substances associated with TUEs at the Summer Olympics were glucocorticoids (0.50% in Rio) and stimulants (0.39% in Tokyo). At the Summer Paralympics, diuretics (0.79% in Rio) and stimulants (0.75% in Tokyo) were the most common. Winter games had somewhat similar trends, although TUE numbers were very low. CONCLUSIONS: The number of athletes competing with valid TUEs at the Olympic and Paralympic games was <1% and <3%, respectively. Variations in substances and methods associated with TUEs for different medical conditions were identified. Nevertheless, numbers were low, further reaffirming that TUEs are not widespread in elite sport.

Mental health surveillance in elite Para athletes: early identification and follow-up of athletes at risk of mental health problems.

OBJECTIVE: There is a lack of prospective data on mental health of elite Para athletes. The objective was to identify and follow elite Para athletes at risk of mental health problems. METHODS: In a 124-week prospective cohort study, mental health of German elite Para athletes was monitored using the Patient Health Questionnaire-4 (PHQ-4). In case of positive screening (PHQ-4≥5) over 2 weeks, a follow-up contact was conducted by a sports psychiatrist, who asked the athletes about their mental condition and sources for their mental distress and offered support. RESULTS: 7543 PHQ-4 scores were obtained from 122 Para athletes with a mean weekly response rate of 84%. The PHQ-4 screening was considered positive for symptoms of depression or anxiety with a prevalence of 6.7%, affecting 48.4% (n=59) of all participants at some point during the study period. In 76.6% (n=49) of all follow-up contacts, athletes (n=34) reported at least one mental health problem, most frequently mental distress (n=31), followed by symptoms of depression (n=19) including acute suicidality (n=1). The most common mental stressors cited were related to education and problems with the team, coaches or federation. At follow-up, almost two-thirds of the athletes were either already in professional psychiatric or psychological care (25%) or were recommended to seek such care (32.8%). CONCLUSION: Our screening and follow-up system revealed high rates of mental health problems in elite Para athletes. Programmes for early identification with mental health monitoring under the supervision of mental health professionals should be considered by sports federations for Para athletes.

Partnerships for the Productive Development of the Health Economic-Industrial Complex: the health question / Parcerias para o Desenvolvimento Produtivo do Complexo Econômico-Industrial da Saúde: a questão da saúde

This paper discusses some of the main criteria used to define priorities for technological and industrial development by the Brazilian Ministry of Health regarding the Partnerships for Productive Development (PDP) Program. In order to focus on the question of how to define priorities for technological development, the methodologies developed by the WHO and the EMA for that purpose are presented. WHO's and Brazilian findings on main causes of burden of disease are briefly compared. WHO's selected findings on major therapeutical gaps and technological development priorities are also compared to priorities selected and supported by the PDP program since its inception. A divorce between medicines prioritized and supported by the PDP program and the main causes of the Brazilian burden of disease was observed. Also, the incremental cost-effectiveness ratios of several medications supported by the program were preliminarily estimated. The resulting ratios were about thirty times higher than the opportunity cost estimated for Brazil. Findings of the above comparisons and cost-effectiveness exercise indicate that inadequate choices were made by the PDP program in the way to a progressive and equanimous universal health access in Brazil, anticipating a low impact on the Brazilian total burden of disease as well as a low effectiveness, efficiency and equity of the program regarding the health of the Brazilian population as a whole.

Estudos brasileiros que analisaram as Parcerias para o Desenvolvimento Produtivo (PDP) apontam limitações do desenho e da implementação das PDPs de medicamentos vis à vis os objetivos de saúde do SUS. Este artigo discute a definição de prioridades para o desenvolvimento tecnológico e industrial do complexo da saúde (CEIS), com foco na universalidade e na equidade em saúde, tendo por objeto o programa de Parcerias para o Desenvolvimento Produtivo (PDP) do Ministério da Saúde, programa de gastos anuais multibilionários, iniciado em 2009. Para aprofundar a questão do processo utilizado para definir prioridades de desenvolvimento tecnológico, o presente trabalho revê as metodologias utilizadas pela OMSepela European Medicines Agency (EMA) para esse propósito. As prioridades de saúde definidas pela OMS, partindo principalmente do critério carga de doença, e as correspondentes lacunas terapêuticas selecionadas para desenvolvimento tecnológico, com base sobretudo em evidências de monitoramento do horizonte e de avaliação tecnológica, são resumidamente apresentadas. A seguir, foram comparados os achados do relatório da OMS_ as prioridades de saúde selecionadas e as prioridades tecnológicas resultantes_ com os achados sobre carga de doença no Brasil e as prioridades selecionadas e apoiadas pelas PDPs. Observou-se um divórcio entre as prioridades medicamentosas apoiadas pelas PDPs e as principais causas de carga de doença no país. Abordamos ainda, nesse artigo, o papel da análise de custo-efetividade e do custo de oportunidade na discussão das escolhas do programa PDP. O exemplo trabalhado indica que o custo de oportunidade de várias tecnologias apoiadas pelas PDPs vigentes é dezenas de vezes superior ao limiar de custo-efetividade estimado para o Brasil. O divórcio entre as prioridades apoiadas pelas PDPs e as principais causas de carga de doença no país e o limiar de custo-efetividade assumido pelo programa PDP indicam escolhas insatisfatórias na busca para alcançar, de forma progressiva e equânime, o acesso universal à atenção de saúde em nosso país, no SUS. Essas escolhas devem resultar em uma baixa efetividade, baixa eficiência e baixa equidade do programa do ponto de vista da saúde da população brasileira como um todo.

Vocal Approach to Transgender Individuals: The Journey Taken in Chile and Argentina

In recent years, there have been international references to the vocal approach for the specific group of transgender individuals, although the Latin American literature is still very timid on this matter. The purpose of this article is to identify the current norms, statistics, and vocal approach towards transgender individuals in Chile and Argentina, considering the experience of two speech and language pathologists with more than twenty years of experience on voice therapy. Reflections were made on the transgender reality in these countries, the limitations in the implementation of the depathologization of the transgender group were outlined, some current and unreliable statistics were presented, some innovative actions in the public system were highlighted, and the lack of knowledge about the benefits of vocal work for transgender men and women was discussed. The identified aspects could benefit from multicenter research that strengthens speech therapy actions with this group, contributing to depathologization and positive approach.

Desde los últimos años es posible encontrar referencias internacionales sobre el abordaje vocal al grupo específico de las personas transgénero, aunque la literatura latinoamericana sigue muy tímida en este asunto. La propuesta de este artículo es identificar las normas vigentes, estadísticas y abordaje vocal hacia las personas transgénero en Chile y Argentina, considerando la experiencia de dos fonoaudiólogas con más de veinte años de experiencia en terapia vocal. Se hicieron reflexiones sobre la realidad transgénero en los países citados, se delinearon las limitaciones en la puesta en práctica de la despatologización del grupo transgénero, se expusieron algunas estadísticas -vigentes y poco confiables-, se plasmaron algunas acciones novedosas en el sistema público y el desconocimiento sobre los beneficios del trabajo vocal en hombres y mujeres transgénero. Los aspectos detectados podrían beneficiarse de investigaciones multicéntricas que fortalezcan acciones fonoaudiológicas con este grupo, contribuyendo a la despatologización y el abordaje positivo.

Study on the policy implementation effect of serious Illness medical insurance in the ethnic minority autonomous area of Western China

Objective: To evaluate the implementation effect of serious illness medical insurance in Guang Xi Zhuang Autonomous Region of western China. Study design: Through the collection of 2017-2021 Guang Xi serious illness medical insurance specific policy making such as fund usage, serious illness compensation, medical expenses data, and data analysis of a serious illness medical insurance effect. Method: Literature research, Policy text analysis, quantitative data collection method, using Excel and SPSS 19.0 data descriptive statistical analysis and comparative analysis. Results: Serious illness medical insurance has had some effect, e.g., from 2017 to 2021, the utilization rate of serious illness medical insurance fund in Guang Xi was 109.49% and 103.87% respectively, the fund balance rate was -9.45% and -8.54% respectively, and the accumulated balance was -2.3871 million CNY and -70.7955 million CNY. Conclusion: The serious illness medical insurance has reduced the burden of large medical expenses of patients to a certain extent, but the fund is under too much pressure, and there is a payment deficit. The coverage and security of serious illness medical insurance need to be expanded and strengthened, and the cooperation mechanism with commercial insurance institutions should be gradually explored to improve the serious illness medical insurance.

Objetivo: evaluar el efecto de la implementación de seguros médicos para enfermedades graves en la Región Autónoma Guang Xi Zhuang, al oeste de China. Diseño del estudio: a través de la recopilación de pólizas de seguro médico específicas para enfermedades graves de la región de Guang Xi entre 2017-2021, como por ejemplo: uso de fondos, compensación por enfermedades graves, datos de gastos médicos y análisis de datos del efecto de seguros médicos para enfermedades graves. Método: investigación de literatura, análisis de textos de políticas públicas, metodología de recolección de datos cuantitativos utilizando Excel y SPSS 19.0, análisis estadístico descriptivo de datos y análisis comparativo. Resultados: el seguro médico para enfermedades graves ha demostrado tener efectos, tales como: entre 2017 y 2021, la tasa de utilización de fondos de seguros médicos para enfermedades graves en Guang Xi fue de 109,49 % y 103,87 % respectivamente, las tasas de saldo del fondo fue de -9,45 % y -8,54 % respectivamente y el saldo acumulado fue de -2,3871 millones de CNY y -70,7955 millones de CNY. Conclusión: El seguro médico para enfermedades graves ha reducido en cierta medida la carga de los grandes gastos médicos de los pacientes, pero al existir un déficit de pagos está bajo demasiada presión. Por ello, es necesario ampliar y fortalecer la cobertura y seguridad del seguro médico para enfermedades graves, y explorar gradualmente mecanismos de cooperación con instituciones de seguros comerciales.

Objetivo: Avaliar o efeito da implementação de seguro médico para doenças graves na Região Autônoma de Guang Xi Zhuang da China Ocidental. Desenho do Estudo: Através da coleta de políticas específicas de seguro médico para doenças graves de Guang Xi 2017-2021, uso de fundos, compensação por doenças graves, dados de despesas médicas e análise de dados de um efeito de seguro médico para doenças graves. Método: Pesquisa na literatura, análise do texto da política, método de coleta de dados quantitativos usando Excel e SPSS 19.0, análise estatística descritiva de dados e análise comparativa. Resultados: Seguro médico de doenças graves teve um certo efeito. Em 2017 e 2021, a taxa de utilização do fundo de seguro médico para doenças graves em Guang Xi foi 109,49% e 103,87% respectivamente, a taxa de saldo do fundo foi -9,45% e -8,54% respectivamente e o saldo acumulado foi -2,3871 milhões de yuans e -70,7955 milhões de yuans. Conclusão: O seguro médico para doenças graves reduziu o ônus de grandes despesas médicas dos pacientes até certo ponto mas o fundo está sob demasiada pressão e há um déficit de pagamentos. A cobertura e segurança do seguro médico de doenças graves necessitam ser expandidas e fortalecidas, e o mecanismo de cooperação com instituições de seguros comerciais deve ser gradualmente explorado para melhorar o seguro médico para doenças graves.

Validation of assessments to accurately analyze the body composition of highly trained sitting volleyball players: A pilot study.

Body composition is a fundamental component of physical fitness related to the performance of Sitting volleyball (SV) players. Also, establishing the best method for evaluating the body composition of these para-athletes would be highly necessary for this field. The purpose of this study was (1) to describe the body composition of male and female highly trained SV players, (2) to compare the values obtained from this population by two different methods and (3) to establish validity on one of these methods. Thirteen Brazilian SV national team players (five males and eight females) participated in this study. The air-displacement plethysmography (ADP) method as the criterion assessment and the skinfolds (SF) method were conducted for each player. Results showed that there were no significant differences between the values of all players, which ADP and SF measured for body fat percentage (BF%) and body density (BD) (p > 0.05). We found significantly different values between male and female players for BF% by SF (p = 0.04) and BD by SF (p = 0.04). A high degree of reliability was found between ADP and SF measures for BF% and BD. There were statistically significant positive correlations between BF% and BD in all values for both methods (p < 0.01). This pilot study suggests that considering the magnitude of space, expense, and other limitations related to the ADP method against the SF method, we recommend using the SF method, which is a valid, viable and reliable method for measuring body composition in elite SV players.

A novel endocardial activation-derived predictor for focal paraseptal atrial tachycardias: evidence from a multicenter cohort study.

BACKGROUND: The electrocardiogram-based algorithm for predicting para-septal atrial tachycardia (PSAT) is limited by the significant overlaps in the P-wave morphology originating from various para-septal sites. OBJECTIVE: The aim of this study was to investigate the endocardial activation characteristics of PSAT and to seek an endocardial activation-derived predictor for the ablation site. METHODS: Forty-four patients (11 males, average 62.6±14.7 years) with PSAT ablation in four tertiary medical centers were assigned into three groups according to the ablation site: right atrial (RA) para-Hisian region (Group 1, n=10), the noncoronary cusp (NCC) (Group 2, n=13) and left atrial (LA) para-septal areas (Group 3, n=21). Multiple-chamber activation mapping was performed guided by a 3D navigation system. The discrepancies in the earliest activation time between two of three chambers (ΔRA-LA, ΔRA-NCC and ΔLA-NCC) were calculated in each group and used for pairwise comparisons. RESULTS: There was significant difference in ΔRA-LA, ΔRA-NCC, and ΔLA-NCC compared among three groups. ΔRA-LA was the only parameter which could consistently predict the ablation site of PSAT with good accuracy (AUC 1.000, sensitivity 100%/ specificity 100%, and cut-off value 7ms for predicting right para-Hisian or NCC ablation; AUC 0.974, sensitivity 92.3%/specificity 95.2%, and cut-off value -4 ms for predicting NCC or left para-septal ablation). Based on two cut-off values, A two-step algorithm was developed to predict the ablation site of PSAT with positive predictive value of 95.4% and negative predictive value of 97.0%. CONCLUSIONS: ΔRA-LA is a useful endocardial activation-derived parameter for predicting the successful ablation site of PSAT.

Phosphine-Catalyzed γ'-Carbon 1,6-Conjugate Addition of α-Succinimide Substituted Allenoates with Para-Quinone Methides: Synthesis of 4-Diarylmethylated 3,4-Disubstituted Maleimides.

In this paper, an interesting γ'-carbon 1,6-conjugate addition for phosphine-catalyzed α-succinimide substituted allenoates has been disclosed. A wide array of substrates was found to participate in the reaction, resulting in the production of diverse 4-diarylmethylated 3,4-disubstituted maleimides with satisfactory to outstanding yields. Furthermore, a plausible mechanism for the reaction was proposed by the investigators.

Ovary and Fallopian Tube Displacement in an Adolescent Patient with a History of Omphalocele.

Omphalocele is an abnormality where fetal abdominal organs protrude through the abdominal wall. We report a case of a 13-year-old female with a history of omphalocele repair who presented with acute periumbilical pain, nausea, and vomiting. Computed Tomography scan showed a para-ovarian cyst and mild dilation of the small bowel. During laparoscopy, the right ovary and fallopian tube were detached from the uterus and located behind the cecum. Despite this displacement, the ovary appeared to have retained functionality with intact blood supply. Authors hypothesize that surgical repair led to pelvic adhesion that caused torsion and avulsion of the fallopian tube and utero-ovarian ligament that led to the displacement. This anatomical change should be taken into consideration in surgical patients with history of omphalocele repair.

Contemporary Role of Radiation Therapy in Testicular Cancer.

Testicular cancer is a rare but curable male malignancy. Seminoma represents the majority of germ cell tumors and is considered radiation sensitive. Radiation treatment plays a role in adjuvant therapy after orchiectomy of stage I, IIA, and IIB seminomas. Radiation dose de-escalation has been effective in preventing tumor recurrences while also limiting acute and long-term toxicities. However, long-term risks, including the prevailing concern of secondary malignancy risk, between adjuvant radiation and chemotherapy play a role in recommendations. Ongoing work continues to be performed to reduce radiation field and dose in combination with chemotherapy while still maintaining excellent outcomes.

Predicting clinical entry point for thoracic epidural catheter insertion during paramedian approach: A prospective observational study.

Background and Aims: Thoracic epidural insertion has high failure rates in the mid-thoracic region due to steep angulation of oblique bending of spinous processes. The preferred skin puncture point for epidural needle insertion in the paramedian sagittal plane with respect to the superior/inferior tip of spinous process or inter-spinous cleft in the mid-thoracic region (T5-8) is not standard. The primary objective of this prospective observational study was to find the skin puncture point which had the best success rate for a successful epidural catheterization. Secondary objectives were to study the number of attempts and passes required to locate epidural space, incidence of failed epidural, and its relationship with patient characteristics and demographics. Material and Methods: After informed consent, 155 patients planned for general anesthesia with epidural analgesia in the mid-thoracic region were included in the trial. Patient demographics, the details of epidural attempts with respect to anatomical landmarks, distance from the midline, and number of passes in each attempt were noted. Epidural catheterization was considered successful after demonstrating dermatomal band of sensory blockade. Results: The success rate at different skin puncture sites was not statistically significant (P = 0.58). We found a failure rate of 12.9%. Failed epidural catheterization was significantly high in the age group >56 years (n = 62 and P = 0.007). Conclusion: In our study, none of the skin puncture points had a significant association with successful epidural insertion in mid-thoracic segments using a para-median approach.

Robot-assisted Surgery with Para-aortic Lymphadenectomy for Endometrial Cancer: A Preliminary Report.

Objectives: There are few reported cases of robot-assisted surgery for endometrial cancer with para-aortic lymphadenectomy (PAL) in Japan. Therefore, this study aimed to examine the clinical outcomes of robot-assisted surgery with PAL for endometrial cancer. Materials and Methods: This retrospective cohort study was analyzed 13 endometrial cancer patients who underwent robotic surgery with PAL between January 2011 and October 2018 at our hospital. We examined their perioperative complications and oncological outcomes. Results: The median follow-up period, median overall survival, and disease-free interval were 80 months, 79 months (61-120), and 79 months (5-120), respectively. There were two (15.3%) cases of perioperative complications of Clavien-Dindo Class II or higher and three (23.0%) cases of recurrence. Conclusion: Our results showed that the surgical and oncological outcomes of robot-assisted surgery for endometrial cancer with PAL were comparable with those of other developed countries.