Percepción de riesgo de lesión y Tendencia al riesgo en relación a la ocurrencia y momento de rehabilitación de Lesiones deportivas en deportistas de Córdoba

La tendencia al riesgo (TR) y la percepción de riesgo de lesión (PRL) son factores asociados a la génesis y la rehabilitación de lesiones deportivas (LD). Se evaluó la relación entre PRL y TR en función de la ocurrencia y momento de rehabilitación de la LD. Participaron 193 deportistas de ambos sexos de entre 18 y 35 años. Se halló que las deportistas lesionadas actualmente o hace más de un año poseen mayores niveles de PRL que deportistas varones, mientras que éstos presentan mayor nivel de PRL que las mujeres cuando la LD ocurrió en la última temporada de competición. Además, se encontraron diferencias en la PRL de actividades de ocio según el momento de rehabilitación de la LD, y que los deportistas lesionados actualmente poseen mayores niveles de TR que los lesionados hace más de un año y aquellos que se lesionaron en la última temporada. Al analizar la interacción entre sexo y momento de ocurrencia de la última lesión deportiva, se encontraron efectos de interacción entre estas variables sobre la percepción de riesgo de LD. Por último, quienes se encuentran en la etapa de readaptación de la LD poseen mayores niveles de TR que quienes se encuentran en las etapas de recuperación y reentrenamiento. Se sugiere que futuras investigaciones aborden variables contextuales como edad, experticia y autoeficacia ya que podrían afectar la PRL, TR, así como la ocurrencia y rehabilitación de la LD

Percepção e tendência a risco em relação à última lesão ocorrida e tempo de reabilitação de lesões em atletas de Córdoba

La tendencia al riesgo (TR) y la percepción de riesgo de lesión (PRL) son variables asociadas a las lesiones deportivas (LD). Se analizó la relación entre PRL y TR en función de la ocurrencia de la última LD y momento de rehabilitación. Participaron 193 deportistas de ambos sexos (98 mujeres y 95 varones) de entre 18 y 35 años (M= 22.56 DT= 4.04). Se encontraron diferencias entre grupo en función del sexo y la edad, siendo las deportistas lesionadas actualmente o hace más de un año poseen mayores niveles de PRL que deportistas masculinos, mientras que éstos presentan mayor nivel de PRL que las mujeres cuando la LD ocurrió en la última temporada. Los deportistas jóvenes adultos mostraron mayores niveles de TR que los jóvenes y adultos, y menores niveles de PRL que éstos. Además, se encontraron diferencias en la PR de actividades de ocio según la etapa de rehabilitación y en la TR en relación a la ocurrencia de la última LD. Hubo un efecto de interacción entre sexo y momento de ocurrencia de la última LD sobre la PRL. Por último, hubo diferencias en TR en función de la etapa de la rehabilitación. En cuanto a la relación entre las variables, se encontró que a mayor PRL, menor TR. Se sugiere que futuras investigaciones aborden variables contextuales como experticia y autoeficacia ya que podrían afectar la PRL, TR, así como la ocurrencia y rehabilitación de la LD.ABSTRACT: Risk propensity (RP) and perceived risk of injury (PRI) are factors associated to the genesis and rehabilitation of sport injuries (SI). The link between RP and PRI was evaluated in athletes with regard to the last SI occurred and rehabilitation phase. The sample was made up of 193 athletes of both sexes (98 female y 95 men) between the ages of 18 and 35 (M= 22.56 DT= 4.04). Female athletes who were currently injured or were injured more than a year ago were found to have higher levels of PRI than male athletes, while males present higher levels of PRI than women when the SI occurred during the last competition season. Also age differences were found, young adults athletes showed higher RP and lowest PRI than young or adult athletes. Differences in the PRI’s levels of recreational activities depending on the rehabilitation phase of the SI were also observed, as well as that currently injured athletes have higher levels of RP than those who were injured more than a year ago and those who were injured the last competition season. Factorial ANOVA indicates that sex and last injury occurrence interact with perceived risk of injury. Last, athletes who are in the readaptation stage of SI have higher levels of RP than those who are in the recovery and retraining stages. Finally, a negative association between RP and PRI was found. It is suggested that future research consider variables such as expertise and athlete’s self- efficacy, given that these variables may affect SI.RESUMO: A Propensão ao risco (PR) e a percepção de risco de lesão (PRL) são fatores associados à gênese e reabilitação de lesões esportivas (LE). A relação entre a PRL e a PR foi avaliada nos atletas de acordo com a fase de ocorrência e reabilitação. Participaram 193 atletas de ambos os (98 mujeres -50.8%- y 95 masculinos -49.2%-) com idade entre 18 e 35 anos (M= 22.56 DT= 4.04). Verificou-se que as atletas que estavam machucadas no momento, ou estiveram há mais de um ano, têm níveis mais elevados da PRL do que os atletas, enquanto eles têm um maior nível de PRL do que as mulheres, quando a LE ocorreu na temporada final da competição. Além disso, diferenças foram encontradas na PR das atividades de lazer, de acordo com a fase de reabilitação da lesão esportiva, e que atletas que estavam machucados no momento têm um maior nível de PR do que aqueles que foram machucados há mais de um ano e na última temporada. Ao analisar a interação entre o sexo e o momento da ocorrência da última lesão esportiva, foram encontrados efeitos de interação entre essas variáveis sobre a percepção ao risco da LE. Portanto, aqueles que estão no estágio de reabilitação da LE têm níveis mais elevados de PR do que aqueles nas fases de recuperação e retreinamento. Sugere-se para futuras investigações a abordagem de variáveis, tais como a idade, experiência e auto-eficácia, uma vez que essas variáveis afetam a PRL, PR, e a ocorrência e reabilitação da LE

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease