Competencias entre fisioterapeutas y educadores físicos-deportivos respecto al ejercicio físico y terapéutico: una revisión narrativa

El ejercicio físico-terapéutico es una reciente herramienta nacida de la fusión del ejercicio físico y la rehabilitación. Debido a su corta edad, no cuenta con un nivel de estructuración definido, originando conflictos entre fisioterapeutas y educadores físico-de- portivos. El objetivo de esta revisión es analizar la bibliografía disponible para buscar unos criterios consensuados. Se realizó una búsqueda en PubMed, utilizando una estrategia basada en la combinación de términos relacionados con el ejercicio físico, el ejercicio terapéutico y su utilización como tratamiento de diversas patologías. Se analizaron un total de 60 programas, de los cuales en tan sólo 4 se especifica el ejercicio terapéutico con respecto al ejercicio físico. Por lo tanto, concluimos que existe una inestabilidad legal en España en cuanto a competencias profesionales, siendo la carga formativa académica universitaria insuficiente para hacer frente a las necesidades de la población general

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

Introduction. Hyperlactatemia occurs during or after extracorporeal circulation in the form of lactic acidosis, increasing the risk of postoperative complications and the mortality rate. The aim of this study was to evaluate whether continuous high-volume hemofiltration with volume replacement through a polyethersulfone filter during the extracorporeal circulation procedure decreases postoperative lactatemia and its consequences. ||Materials and methods. This was a randomized controlled trial. Patients were randomly divided into two groups of 32: with or without continuous high-volume hemofiltration through a polyethersulfone membrane. Five patients were excluded from each group during the study period. The sociodemographic characteristics, filter effects, and blood lactate levels at different times during the procedure were evaluated. Secondary endpoints were studied, such as the reduction in the intubation time and time spent in ICU. ||Results. Lactatemia measurements performed during the preoperative and intraoperative phases were not significantly different between the two groups. However, the blood lactate levels in the postoperative period and at 24 hours in the intensive care unit showed a significant reduction and a possible clinical benefit in the hemofiltered group. Following extracorporeal circulation, the mean lactate level was higher (difference: 0.77 mmol/L; CI 0.95: 0.01–1.53) in the nonhemofiltered group than in the hemofiltered group (p<0.05). This effect was greater at 24 hours (p = 0.019) in the nonhemofiltered group (difference: 1.06 mmol/L; CI 0.95: 0.18–1.93) than in the hemofiltered group. The reduction of lactatemia is associated with a reduction of inflammatory mediators and intubation time, with an improvement in liver function. || Conclusions. The use and control of continuous high-volume hemofiltration through a polyethersulfone membrane during heart-lung surgery could potencially prevent postoperative complications. The reduction of lactatemia implied a reduction in intubation time, a decrease in morbidity and mortality in the intensive care unit and a shorter hospital stay.14 páginas

Sun Exposure during Water Sports: Do Elite Athletes Adequately Protect Their Skin against Skin Cancer?

Excessive sun exposure is the main avoidable cause of skin cancer. Outdoor sports performed without adequate photoprotection are risky practices in this respect. This study examines whether elite athletes in water sports (specifically surfing, windsurfing, and sailing) take appropriate measures to protect their skin from the sun, and whether there are differences in this respect according to age, gender, or sports discipline. This study is based on a questionnaire-based health survey. World championship competitors completed a self-administered questionnaire on their sun protection and exposure habits, as well as sunburns during the last sports season. In total, 246 participants, with an age range of 16-30 years, completed the questionnaire. Of these, 49.6% used inadequate sun protection. Those who protected their skin appropriately tended to be older than those who did not (average age = 23.28 and 20.69 years, respectively; p = 0.000). There were no significant differences in sun protection habits between male and female athletes. The rate of sunburn was very high (76.7%). A high proportion (22.5%) of participants never used sunscreen. Elite athletes in water sports are at real risk of skin lesions from overexposure to the sun, associated with inadequate photoprotection practices. Campaigns to raise awareness and to promote the early detection of skin cancer should target these risk groups

Hamstring extensibility in female elite soccer players

El objetivo de este estudio fue evaluar la extensibilidad de la musculatura isquiosural en futbolistas femeninas de élite. Se realizó un estudio descriptivo transversal en una muestra de 75 jugadoras de élite de fútbol de cuatro categorías: Sub12 (n=20, edad: 11,42 ± 0,90 años), Sub15 (n=21, edad: 13,38 ± 1,50 años), Provincial (amateur) (n=15, edad: 17,13 ± 1,85 años), y Nacional (profesional) (n=20, edad: 22,80 ± 5,25 años). Como instrumentos de medición se utilizaron el test sit and reach (SRT) y el test de flexión profunda (FP) de tronco. Los valores medios presentados en el SRT fueron de 9,74 ± 5,62 cm. para el grupo Sub12, 13,86 ± 4,82 cm. para el grupo Sub15, 9,73 ± 3,58 cm para el grupo Provincial (amateur) y 7,55 ± 8,39 cm para el grupo Nacional (profesional). En el SRT las participantes del grupo Sub15 obtuvieron resultados significativamente superiores que las participantes del grupo Nacional (p<.05), mientras que en la prueba FP el grupo Sub12 obtuvo resultados significativamente superiores que el grupo Nacional (p<.05). En el análisis de correlaciones bivariadas, se observaron correlaciones moderadas entre la altura y los resultados en las pruebas de FP (r=.561; p<.05) y SRT (r=.491; p<.05) en el grupo Sub12. En conclusión, los resultados de este estudio indican que la extensibilidad isquiosural de las jugadoras de élite de fútbol estudiadas es limitada, por lo que deberíamos implementar programas específicos de estiramientos de la musculatura isquiosural en futbolistas féminas desde las categorías inferiores hasta las categorías profesionales. Palabras clave. flexibilidad, fútbol femenino, flexión profunda, sit and reach test.The aim of this study was to evaluate hamstring extensibility in female elite soccer players. A descriptive transversal study was carried out with a sample of 75 female elite soccer players into four categories: Under12 (n=20, age: 11,42 ± 0,90 years), Under15 (n=21, age: 13,38 ± 1,50 years), Provincial (amateur) (n=15, age: 17,13 ± 1,85 years), and National (professional) (n=20, age: 22,80 ± 5,25 years). The sit and reach test (SRT) and the deep trunk flexion test were used as measurement tools. The average values showed in the SRT were 9,74 ± 5,62 cm. for the Under12 group, 13,86 ± 4,82 cm. for the Under15 group, 9,73 ± 3,58 cm for the Provincial (amateur) group and 7,55 ± 8,39 cm for the National (professional) group. In the SRT the members of Under15 group showed significantly higher results than the members of National group (p<.05), while in the deep trunk flexion test the Under12 group showed significantly higher results than the National group (p<.05). In the analysis of bivariate correlations, in the Under12 group moderate correlations were observed between height and scores in the deep trunk test (r = .561; p <.05) and SRT (r = .491; p <.05). In conclusion, the results of this study indicate that the hamstring extensibility in female elite soccer players studied is limited, so we should implement stretching specific programs of the hamstring muscles in female soccer players from the lower categories to the professional categories. Key words. flexibility, female soccer, deep trunk, sit and reach test

What Sun Protection Practices Should Be Adopted by Trainee Teachers to Reduce the Risk of Skin Cancer and Other Adverse Outcomes?

Excessive sun exposure and insufficient protection are the main risk factors for the onset of melanoma and non-melanoma skin cancer (the most common types of cancer suffered by fair-skinned populations) and other adverse effects on the skin and eyes. Epidemiological data highlight the scant awareness of this risk among young people and the high rates of sunburn often recorded among this population. The main aim of the present study is to examine sun exposure and protection behavior by university students. A cross-sectional questionnaire-based study was undertaken to investigate sun exposure and protection practices among students of education sciences at a university in southern Spain. The data obtained were used to perform a descriptive, comparative analysis, by groups and by gender, of photoprotection and skin self-examination practices. The reliability and validity of the questionnaire were both tested. Of the 315 students who completed the questionnaire, 74.6% had suffered at least one sunburn during the previous year. Few made frequent use of sunscreen or protective clothing and 89.5% did not self-examine their skin. The metric properties of the questionnaire revealed its excellent reliability and validity. Among the Spanish university students considered, there was little awareness of the risk of excessive sun exposure, self-protection was insufficient, the potential exposure to dangerous levels of ultraviolet radiation was high, and most had suffered one or more sunburns in the last year. Intervention strategies should be implemented to highlight the risks involved and the need for more appropriate sun protection practices. Information campaigns should be conducted in this respect so that, when these students become teachers, they will have adequate knowledge of the risks involved and of the benefits of addressing this problem effectively, and will ultimately transfer these health education competences to their own students

Social inequalities in multimorbidity patterns in Europe: A multilevel latent class analysis using the European Social Survey (ESS)

Multimorbidity is associated with lower quality of life, greater disability and higher use of health services and is one of the main challenges facing governments in Europe. There is a need to identify and characterize patterns of chronic conditions and analyse their association with social determinants not only from an individual point of view but also from a collective point of view. This paper aims to respond to this knowledge gap by detecting patterns of chronic conditions and their social determinants in 19 European countries from a multilevel perspective. We used data from the ESS round 7. The final sample consisted of 18,933 individuals over 18 years of age, and patterns of multimorbidity from 14 chronic conditions were detected through Multilevel Latent Class Analysis, which also allows detecting similarities between countries. Gender, Age, Housing Location, Income Level and Educational Level were used as individual covariates to determine possible associations with social inequalities. The goodness-of-fit indices derived in a model with six multimorbidity patterns and five countries clusters. The six patterns were "Back, Digestive and Headaches", "Allergies and Respiratory", "Complex Multi -morbidity", "Cancer and Cardiovascular", "Musculoskeletal" and "Cardiovascular"; the five clusters could be associated with some geographical areas or welfare states. Patterns showed significant differences in the cova-riates of interest, with differences in education and income being of particular interest. Some significant dif-ferences were found among patterns and the country groupings. Our findings show that chronic diseases tend to appear in a combined and interactive way, and socioeconomic differences in the occurrence of patterns are not only of the individual but also of group importance, emphasising how the welfare states in each country can influence in the health of their inhabitants

Validation of an Online Version of the Alcohol Use Disorders Identification Test (AUDIT) for Alcohol Screening in Spanish University Students

Online alcohol screening may be helpful in preventing alcohol use disorders. We assessed psychometric properties of an online version of the Alcohol Use Disorders Identification Test (AUDIT) among Spanish university students. We used a longitudinal online survey (the UNIVERSAL project) of first-year students (18-24 years old) in five universities, including the AUDIT, as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. A reappraisal interview was carried out with the Timeline Followback (TLFB) for alcohol consumption categories and the Mini International Neuropsychiatric Interview (MINI) for alcohol use disorder. Reliability, construct validity and diagnostic accuracy were assessed. Results: 287 students (75% women) completed the MINI, of whom 242 also completed the TLFB. AUDIT's Cronbach's alpha was 0.82. The confirmatory factor analysis for the one-factor solution of the AUDIT showed a good fit to the data. Significant AUDIT score differences were observed by TLFB categories and by MINI disorders. Areas under the curve (AUC) were very large for dependence (AUC = 0.96) and adequate for consumption categories (AUC > 0.7). AUDIT cut-off points of 6/8 (women/men) for moderate-risk drinking and 13 for alcohol dependence showed sensitivity/specificity of 76.2%/78.9% and 56%/97.5%, respectively. The online version of the AUDIT is useful for detecting alcohol consumption categories and alcohol dependence in Spanish university students.This research was funded by Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III FEDER (PI13/00343); Ministerio de Sanidad, Consumo y Bienestar Social, Plan Nacional Sobre Drogas PNSD (exp.2015I015); and from the DIUE of the Generalitat de Catalunya (2017SGR452). L. Ballester was supported by an FPU grant (FPU15/05728); M. J. Blasco was supported by a Rio Hortega grant (ISCIII, CM14/00125); P. Castellvi was supported by a Sara Borrell grant (ISCIII, CD12/00440), the European Regional Development Fund (ERDF), the European Commission, the University of Jaen, Spain (R08/06/2018) and the Instituto de Estudios Giennenses; and P. Mortier was supported by a Sara Borrell grant (ISCIII, CD18/00049)

Multimorbidity Patterns and Their Association with Social Determinants, Mental and Physical Health during the COVID-19 Pandemic

Background: The challenge posed by multimorbidity makes it necessary to look at new forms of prevention, a fact that has become heightened in the context of the pandemic. We designed a questionnaire to detect multimorbidity patterns in people over 50 and to associate these patterns with mental and physical health, COVID-19, and possible social inequalities. Methods: This was an observational study conducted through a telephone interview. The sample size was 1592 individuals with multimorbidity. We use Latent Class Analysis to detect patterns and SF-12 scale to measure mental and physical quality-of-life health. We introduced the two dimensions of health and other social determinants in a multinomial regression model. Results: We obtained a model with five patterns (entropy = 0.727): ‘Relative Healthy’, ‘Cardiometabolic’, ‘Musculoskeletal’, ‘Musculoskeletal and Mental’, and ‘Complex Multimorbidity’. We found some differences in mental and physical health among patterns and COVID-19 diagnoses, and some social determinants were significant in the multinomial regression. Conclusions: We identified that prevention requires the location of certain inequalities associated with the multimorbidity patterns and how physical and mental health have been affected not only by the patterns but also by COVID-19. These findings may be critical in future interventions by health services and governments17 página

Self-esteem and suicidal behaviour in youth: A meta-analysis of longitudinal studies

Background: Previous literature suggests that low self-esteem is a risk factor for suicide attempts, but no meta-analyses have been conducted to assess this association in adolescents/young adults. The present study examined the relationship between low self-esteem and suicide attempts in young people (12-26 years old). Method: Meta-analyses were performed using random-effects models (ES) and odds ratio (OR). Heterogeneity and sensitivity analyses were performed. Results: From 26,883 initial titles, 22 studies met the inclusion criteria, of which 9 studies had data that could be included in the meta-analysis. The meta-analysis showed that youths with lower self-esteem were more likely to have future suicide attempts, with an effect size (self-esteem as continuous variable) of d = .58 (95% CI = .44 - .73) and, for low self-esteem (categorical variable) an OR = 1.99 (95% CI = 1.39-2.86; p < .001). Conclusion: A low level of self-esteem is a risk factor for suicide attempts in adolescents/young adults