Nuevos sistemas de comunicación del método Pilates en embarazo y puerperio = New communications systems of Pilates Method in pregnancy and postpartum period

Resumen: Introducción: En los últimos años se ha incentivado a la mujer para realizar actividad física durante la gestación como método preventivo en las lesiones relacionadas con el suelo pélvico, destacando el método Pilates. Además, las nuevas tecnologías de la información y la comunicación (TICs) permiten el aprendizaje desde los domicilios. Objetivos: Mostrar los beneficios del método Pilates en el suelo pélvico. Conocer el uso y la satisfacción de las mujeres que usan este método durante la gestación y el puerperio, incorporando las nuevas tecnologías de la información y la comunicación (TICs). Material y método: Para el diseño del estudio se realizó una revisión bibliográfica en las diferentes bases de datos biosanitarias. Como resultado de la búsqueda y análisis de los documentos encontrados, se seleccionaron 18 artículos que se adecuaban a los criterios de inclusión y exclusión. Resultados: El Método Pilates produce numerosos beneficios aplicado durante la gestación y el puerperio. El uso de nuevos sistemas de comunicación genera mayor implicación de las embarazadas en su aprendizaje y la posterior continuación de su práctica. Discusión y conclusiones: El uso de este método incorporando las nuevas tecnologías es muy beneficioso, tanto en aspectos físicos como psicológicos de la mujer, previniendo numerosas patologías asociadas al embarazo, aportando mayor confianza a la mujer durante el período de parto.Palabras clave: Pilates, Suelo pélvico, Gestación, Salud, ComunicaciónAbstract: Introduction: Over the past years, women have been encouraged to practise physical activity during pregnancy as a preventive method to injuries related to the pelvic floor, mainly the Pilates Method. Besides, new information and communication technologies (TICs) allow learning it at home. Objectives: To show Pilates´ benefits on pelvic floor. To know the use and satisfaction of women who use this method during pregnancy and the postpartum period, incorporating new information and communication technologies (TICs). Material and Method: For the study design, a literature review was made in different biohealth data bases. As a result of the search and analysis of the literature, 18 articles that suited the inclusion and exclusion guidelines were selected and found. Results: The Pilates method produces a lot of benefits applied during pregnancy and the postpartum period. The use of new communication systems generates greater involvement of pregnant women in their learning and the continuation of its practice. Discussion and conclusions: The use of this method incorporating new technologies has very beneficial aspects in women, both physical as psychological, preventing many diseases associated with pregnancy, giving greater confidence to women during the period of childbirth.Keywords: Pilates, Pelvic floor, Pregnancy, Health, Communication 

Efecto del ejercicio físico sobre la concentración de adipocinas en adultos con obesidad. Una revisión sistemática

Introduction: In obesity, adipose tissue causes alterations in the regulation of adipokines, while the type of exercise can influence its secretion at the systemic level. Aim: The aim was to perform a systematic review of published evidence about the effect of different types of exercise on the adipokines concentration in adults with obesity. Method: A search through PubMed, EBSCO (Medline, MedicLatina), and Google Scholar databases was performed. The descriptors used were the following: in English, "adipocytokines" OR "adipokines", "exercise" OR "physical activity" OR "training", "adults" AND "obese"; in Spanish, "adipocinas", "ejercicio" or "actividad física", "adultos" and "obesidad". The inclusion criteria were: original, randomized controlled articles, published between 2005 and 2018, in English and Spanish, with exercise intervention describing type, intensity, frequency and duration. It was taken into account that the intervention had been performed in adults who were overweight or obese. Results: were located 751 articles, of which only 13 studies met the inclusion criteria. Of these n = 8 studies report results of aerobic exercise, n = 1 anaerobic, n = 1 mixed and n = 3 in which they used different exercise modalities separately as aerobic, anaerobic and / or mixed. An increase in adiponectin concentrations is reported, as well as a decrease in levels of leptin and tumor necrosis factor alpha. Conclusion: According to the literature reviewed, improvements in adipokine levels are observed after an intervention greater than 10 weeks with aerobic and anaerobic exercise of moderate and vigorous intensity.Objetivo: realizar una revisión sistemática de la evidencia publicada para determinar el efecto de diferentes tipos de ejercicio en la concentración de adipocinas en adultos con obesidad. Método: Se realizó una búsqueda en las bases de datos PubMed, EBSCO (Medline, MedicLatina) y el buscador Google Académico. Los descriptores utilizados fueron los siguientes: en inglés, “adipocytokines” OR “adipokines”, “exercise” OR “physical activity” OR “training”, “adults” AND “obese”; en español, “adipocinas”, “ejercicio” o “actividad física”, “adultos” y “obesidad”. Resultados: Se incluyeron 13 estudios de diferentes modalidades de ejercicio como aerobio, anaerobio y mixto. Se reporta un aumento en las concentraciones de adiponectina, así como una disminución en los niveles de leptina y (factor de necrosis tumoral alfa) TNFα.  Conclusión: Se observó que existe un mayor beneficio con el ejercicio aerobio marcando mejoras en los niveles de adipocinas

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research