India's health and wellness centres: realizing universal health coverage through comprehensive primary health care.

In common with other countries in the World Health Organization South-East Asia Region, disease patterns in India have rapidly transitioned towards an increased burden of noncommunicable diseases. This epidemiological transition has been a major driver impelling a radical rethink of the structure of health care, especially with respect to the role, quality and capacity of primary health care. In addition to the Pradhan Mantri Jan Arogya Yojana insurance scheme, covering 40% of the poorest and most vulnerable individuals in the country for secondary and tertiary care, Ayushman Bharat is based on an ambitious programme of transforming India's 150 000 public peripheral health centres into health and wellness centres (HWCs) delivering universal, free comprehensive primary health care by the end of 2022. This transformation to facilities delivering high-quality, efficient, equitable and comprehensive care will involve paradigm shifts, not least in human resources to include a new cadre of mid-level health providers. The design of HWCs and the delivery of services build on the experiences and lessons learnt from the National Health Mission, India's flagship programme for strengthening health systems. Expanding the scope of these components to address the expanded service delivery package will require reorganization of work processes, including addressing the continuum of care across facility levels; moving from episodic pregnancy and delivery, newborn and immunization services to chronic care services; instituting screening and early treatment programmes; ensuring high-quality clinical services; and using information and communications technology for better reporting, focusing on health promotion and addressing health literacy in communities. Although there are major challenges ahead to meet these ambitious goals, it is important to capitalize on the current high level of political commitment accorded to comprehensive primary health care.

The use of supplements and performance and image enhancing drugs in fitness settings: A exploratory cross-sectional investigation in the United Kingdom.

OBJECTIVE: The strive for perfection is prevalent in the fitness industry. This study aimed to explore the use of products to enhance performance alongside exposure to exercise addiction, appearance anxiety and self-esteem in fitness settings. METHODS: An online survey was prepared and piloted before wider dissemination in fitness clubs via snowballing and selected mailing lists. A list of commonly used products, including Performance and Image Enhancing Drugs (PIEDs) was provided. Exercise addiction (Exercise Addiction Inventory; EAI), anxiety levels (Appearance Anxiety Inventory; AAI) and their self-esteem (Rosenberg's Self-Esteem Scale; RSE) were also measured. RESULTS: 377 questionnaires were completed. A significant number of participants declared the use products either to lose weight (16%) or to reach their fitness goals (41%). The Internet played a major role in both the supply of information and the provision of the enhancement products (33.7%) and side effects were reported (10.5%). Only a limited number of participants sought a medical opinion about taking products (5.1%). EAI scores were high (m=20.02 ± 4.1), AAI (m=15.98 ± 4.8) showed an intermediate level of anxiety, while self-esteem was low (RSE m=12.59 ± 2.2). CONCLUSION: This pilot study identified the emergence of a new drug trend in fitness settings and showed a potential relationship to exercise addiction, anxiety disorders and low self-esteem. The Internet played a crucial role in disseminating often untested products, including PIEDs without medical supervision and unwanted side-effects were reported. More studies in the field are required in order to safeguard public health and inform policy making.

Measuring empathy feelings in football through media value / Valor mediático en el fútbol y grado de afinidad de los fans

This paper applies media value appraisals to measure the degree of identification that players and teams inspire in football supporters. Using a large data set of media value scores in season 2014/15, we rank the most popular football players and clubs worldwide; as well as the teams’ managers with the greatest media value exposure. Then, building upon individual ratings, we determine the hierarchy of the 'Big Five' European domestic leagues, according to their comparative media value status

En este artículo se emplean indicadores de valor mediático en el fútbol para estimar el grado de identificación que jugadores y clubs inspiran entre los aficionados. A partir de amplias bases de datos del valor mediático en la temporada 2014/15, se elaboran los rankings mundiales de jugadores y clubs, así como el ranking de los entrenadores con mayor visibilidad en los medios. Además, agregando registros individuales, puede determinarse la jerarquía de estatus mediático de las cinco grandes ligas domésticas de Europa

Ocio en la naturaleza como espacio de desarrollo juvenil / Leisure in nature as a space for youth development

El objetivo del artículo consiste en describir las implicaciones positivas que la realización de actividades de ocio en la naturaleza tiene en el desarrollo de la juventud, frente a aquellas actividades que se realizan en otros espacios. Para ello se analiza la principal actividad de ocio de los jóvenes (hombres y mujeres) que cursan estudios secundarios postobligatorios en el estado español, en relación con aspectos vinculados a los beneficios percibidos de su experiencia de ocio (físicos, emocionales, cognitivos, conductuales y sociales), el grado de responsabilidad y gestión por parte de los jóvenes de dicha práctica y, el grado de satisfacción y la importancia en su vida de esa práctica principal de ocio. Además, se caracterizan dichas prácticas, para poder visualizar los aspectos diferenciadores respecto a otro tipo de prácticas. Todo ello se realiza a través de la explotación de un cuestionario diseñado ad hoc, con una muestra de 1750 jóvenes de todo el estado español, tanto de diferentes tipos de enseñanza, como de instituciones de carácter público y privado

The objective of this article is to describe the positive implications that the practice of leisure activities in nature has in youth development, unlike those activities that take place in other areas. In order to do this, we analysed the main leisure activity of young women and men that are in post compulsory education in the Spanish school system, in relation to aspects linked to the benefits of this leisure experience (physical, emotional, cognitive, behavioural and social) and the level of responsibility and management of this young people, as well as the level of satisfaction and the importance that this practise has on their lives. Besides, we typified this practice, in order to visualise the distinguishing elements in relation to other different activities. All of this has been carried out through a questionnaire designed ad hoc and handed to a sample of 1750 students in the Spanish school system, both state and private schools

Noise levels in fitness classes are still too high: evidence from 1997-1998 and 2009-2011.

Fitness instructors routinely use high music volumes that may be harmful to hearing. This study assessed noise levels during 35 low-intensity and 65 high-intensity fitness classes in 1997-1998 and 2009-2011. Questionnaires examined instructors' and clients' preferred music volumes and whether they found loud music "stressful" or "motivating." Noise levels in 1997-1998 and 2009-2011 were similar, frequently exceeding 90 dB(A). Although noise levels in low-intensity classes dropped from 88.9 to 85.6 dB(A), they remained high for high-intensity classes, averaging 93.1 dB(A). In 2009-2011, instructors preferred significantly higher volumes than clients for high-intensity classes. In both time periods, about 85% of instructors found loud music motivating, whereas about one fifth of clients found it stressful. The results suggest that noise exposure from fitness classes, particularly high-intensity classes, continues to pose a potential risk to hearing.

Efecto del deporte en el bienestar psicológico de las personas con gran discapacidad física de origen neurológico / Effect of sports in psychological well-being of persons with severe physical disability of neurological origin

La discapacidad física de origen neurológico produce una importante limitación funcional y afectación psicológica que se manifiesta en un menor bienestar personal. La actividad física rehabilitadora y la práctica deportiva forman parte del proceso rehabilitador, pero su efecto en el bienestar no ha sido bien valorado. Objetivo. Este estudio se ha centrado en analizar la relación entre el bienestar psicológico y el tipo de práctica deportiva en personas con discapacidad física de origen neurológico. Sujetos y métodos. Se evaluó el bienestar psicológico de un total de 160 personas con discapacidad mediante el Índice de Bienestar Psicológico (IBP), categorizados en 4 grupos en relación con la práctica de actividad física: rehabilitación, deporte recreación, deporte competición y sedentarios. Resultados. Los resultados muestran que los participantes del grupo de sedentarios presentan significativamente un menor bienestar psicológico para todas las dimensiones del IBP, excepto para la dimensión de bienestar, que el resto de grupos. Por otro lado, los participantes del grupo de deporte de competición presentan valores superiores en las dimensiones de autocontrol y de salud general. Conclusiones. La práctica de actividad deportiva, especialmente competitiva repercute en un mayor bienestar psicológico en personas con gran discapacidad (AU)

Introduction. Severe physical disability having a neurological origin causes significant functional limitation and psychological effects. This is manifested in less personal well-being. Rehabilitative physical activity and practicing sports form a part of the rehabilitation process. However, their effect on well-being has not been positively valued. Objective. This study has focused on the analysis of the relationship between psychological well-being and the type of sport practiced in persons having neurological-based physical disabilities. Subjects and methods. Psychological well-being of 160 disabled persons was assessed using the Psychological Well-Being Index (PWBI). They were categorized into four groups in relation to the practice of physical activity: rehabilitation, sports recreation, sports competition and sedentary activities. Results. The results show that participants in the sedentary group had significantly lower psychological well-being for all the PWBI dimensions than the other groups, except for the welfare dimension. On the other hand, the participants in competitive sports had higher values in self-control and general health dimensions. Conclusions. The practice of sports, especially competitive ones, has an impact on greater psychological well-being in people with severe disabilities (AU)

Corpos, dores, subjetivações: notas de pesquisa no esporte, na luta, no balé / Bodies, pains, subjectivness: research notes on sport, fight, dance

Investigamos o atletismo, o caratê e o balé, interessando-nos pelos dispositivos de subjetivação que se instituem por meio de técnicas, rotinas, rituais, representações e discursos que os sujeitos elaboram, atualizam, repetem, reconstituem, tomando como núcleo as relações com o corpo mediadas pelo treinamento. Para tal, realizamos incursões etnográficas em uma academia de dança, uma equipe de atletismo e um dojo de caratê. A análise do material empírico permite dizer que é a trama entre técnica, dor, sofrimento e projeto, um eixo central na conformação subjetiva de atletas, lutadores e bailarinas.

This paper presents some results of a research whose aim was to investigate subjective dispositives by athletic athletes, karate fighters and ballerinas. Those dispositives are marks of the relations between body and training through techniques, routines, rituals, representations and discourses elaborated by the subjects. Ethnographical practices were made in a dance school, an athletics'team, in a karate group. The results show the intersection between technique, pain, suffering and project are parts of an axis of subjective conformation of athletes, fighters and ballerinas.

Investigamos, tomando en cuenta las relaciones con el cuerpo mediadas por el entrenamiento, el atletismo, el carate y el balé, buscando dispositivos de subjetivación que se instituyen en las técnicas, rutinas, rituales representaciones y discursos que lós sujetos elaboran, actualizan, repiten, reconstituyen. Realizamos incursiones etnográficas en una escuela de danza, en una equipo de atletismo y en un Dojo de carate. El análisis del material empírico permite decirque es la trama entre técnica, dolor, sufrimiento y proyecto, uno de los ejes de conformación subjetiva de atletas, luchadores y bailarines.

¿Cómo influye en los pacientes crónicos de hemodiálisis la organización de actividades de ocio durante sus sesiones? / How does the organization of leisure activities during session influence chronic patients on haemodialysis?

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Propuesta de un modelo explicativo del bienestar psicológico en el contexto deportivo / A proposal for an explanatory model of psychological well-being within the context of sport

El objetivo de este estudio fue poner a prueba un modelo teórico que explique el bienestar psicológico en el contexto del deporte. El modelo hipotetizó la influencia de la percepción del clima motivacional a la tarea, la inteligencia emocional percibida, la orientación a la tarea y la motivación intrínseca sobre el bienestar psicológico. Los participantes fueron 399 deportistas españoles, 281 hombres y 118 mujeres. El modelo de ecuaciones estructurales mostró que la inteligencia emocional percibida medió parcialmente la relación entre el clima motivacional a la tarea y la orientación a la tarea, donde la orientación a la tarea influyó sobre la motivación intrínseca y ésta, a su vez, sobre el bienestar psicológico. Además, la inteligencia emocional percibida influyó directamente sobre el bienestar psicológico. El modelo se mostró invariante respecto a la variable aficionados versus profesionales. Los resultados son discutidos en el marco de la teoría de la autodeterminación y la teoría de las metas de logro (AU)

The aim of this study was to test a theoretical model that would explain psychological well-being within the contexts of sport. The model hypothesised the influence of the perceived task motivation climate, perceived emotional intelligence, task orientation and intrinsic motivation on psychological well-being. The participants were 399 Spanish athletes, 281 of whom were male and 118 female. Structural equation modelling showed that perceived emotional intelligence partially mediated the relationship between task motivational climate and task orientation, in which task orientation influenced intrinsic motivation and in turn, intrinsic motivation influenced psychological well-being. Furthermore, perceived emotional intelligence directly influenced psychological well-being. The model was invariant across two sport settings: amateur versus professional athletes. The findings are discussed within the framework of the selfdetermination and achievement goal theories (AU)

Atividades físicas de aventura na natureza (AFAN) e academias de ginástica: motivos de aderência e benefícios advindos da prática / Aventuras en la naturaleza e actividades en gimnasios: adherencias e beneficios con la practica / Outdoor adventure and gym activities: adherence and practical benefits

O objetivo desta pesquisa quali-quantitativa foi investigar, na visão de praticantes regulares, os principais fatores de aderência às atividades físicas de aventura na natureza (AFAN) e aos exercícios praticados em academias, no âmbito do lazer, bem como as possíveis alterações físicas e psicológicas advindas da prática regular. A entrevista semiestruturada foi aplicada a uma amostra formada por 20 sujeitos praticantes de AFAN e por 20 adeptos de exercícios em academias e, os dados coletados, foram analisados descritivamente, utilizando-se a técnica de Análise de Conteúdo Temático.

The objective of this quali-quantitative research was to compare the mainly adherence aspects in outdoor adventures and in indoor gym activities, during the leisure time; and, consequently the physical and psychological changes and benefits brought through a regular practice. It was conducted 40 semi-structured interviews, 20 with practitioners of Adventure Activities and 20 with persons engaged in gym exercises. Data was descriptively analyzed through Content Analysis.

El objetivo de esta pesquisa cuali-cuantitativa fue investigar en la percepción de lo practicantes las principales causas y factores para la adherencia en las actividades de aventura en la naturaleza y a los ejercicios en los gimnasios, así como las alteraciones psicológicas de una práctica regular. Fueron realizadas 40 entrevistas semi-estructuradas con 20 practicantes de actividades físicas en la naturaleza y 20 con adeptos a ejercicios en gimnasios y los resultados fueron analizados utilizándose la técnica de “Analise de Conteudos Tematicos”.

Doping in fitness sports: estimated number of unreported cases and individual probability of doping.

AIMS: Recent studies have suggested that the use of doping substances and particularly of anabolic androgenic steroids (AAS) is often practised by fitness centre visitors. These studies employed direct interview techniques and questionnaires to assess the estimated number of unreported cases of doping. Because people hesitate to provide compromising information about themselves, these techniques are subject to response errors. In this study we applied an alternative interview technique to assess more accurately unreported cases of doping in fitness centres. DESIGN AND PARTICIPANTS: The present investigation employed the randomized response technique (RRT) to reduce response errors. A cohort of 500 people from 49 fitness centres participated in this study. FINDING: The RRT revealed a high prevalence of doping (12.5%). In addition, and most importantly, the present RRT study revealed an alarmingly high prevalence of illicit drug use, specifically of cocaine use, that has been severely underestimated by previous studies. CONCLUSIONS: The RRT confirmed previously estimated rates of AAS use assessed by direct interview techniques and voluntary questionnaires, but uncovered a much higher usage rate of illicit drugs among fitness centre visitors. This outcome enabled us to construct a 'probability' rating for the use of doping substances in fitness centre visitors. Given its high prevalence and the predominant use of AAS, doping among fitness centre visitors is an issue of extreme relevance for the health care system. Our study may help to characterize further doping substance users and to develop and apply prevention and intervention programmes specifically to individuals at high risk.

Perfil dos indivíduos que iniciam programas de exercícios em academias, quanto à composiçäo corporal e aos objetivos em relação a faixa etária e sexo / Profile of individuals who starts exercise programs in gyms, as to body composition and goals in relation to age and sex

A busca de melhor qualidade de vida nos últimos anos faz aumentar o número de pessoas preocupadas com a redução do peso corporal. Muitos indivíduos procuram atividades físicas regulares como forma alternativa de tratamento. O objetivo deste estudo foi investigar o perfil dos indivíduos que iniciam programas de exercícios em academias, quanto à composição corporal e aos objetivos em relação à faixa etária e ao sexo. Pesquisa transversal, com amostragem de 90 homens e 89 mulheres, composta por alunos iniciantes de uma academia em Curitiba, avaliados entre agosto de 1998 e setembro de 1999. Para a coleta de dados os alunos preencheram uma ficha que continha objetivos predeterminados. As medidas antropométricas, massa corporal, estatura e dobras cutâneas seguiram as indicações de Wartenweiler et al. (1974). No cálculo da densidade corporal em adultos utilizou-se a fórmula de Petroski (1995) - 4 dobras cutâneas. Para a estimativa do percentual de gordura (porcentagem G) em adultos a fórmula de Siri (1961). O tratamento estatístico foi com o teste ®t¼ de Student para grupo independentes. Foram observadas diferenças significativas (p<0,05), para o índice de massa corporal (IMC) e porcentagem G nos homens, e, para porcentagem G nas mulheres entre as faixas etárias. Para os indivíduos de 20 a 30 anos, 45,7 por cento dos homens desejam aumentar massa muscular; 54,9 por cento das mulheres esperam reduzir peso. Entre 30 e 40 anos, 35 por cento dos homens desejam redução de peso corporal. Embora 55 por cento das mulheres entre 20 e 30 anos desejem redução de peso corporal, somente 16,9 por cento delas realmente necessitam. Pode-se concluir que o incremento da gordura corporal ocorre em ambos os sexos com o avanço da idade e que a análise dos valores médios e porcentagem G e IMC indicam que homens e mulheres têm sua condição de saúde agravada e seus objetivos modificados com a idade