Inhaloterapia en el manejo de las enfermedades respiratorias

El tratamiento se fundamenta en el uso de medicamentos por vía inhalada, ya que presenta grandes ventajas frente a las otras vías de administración al llegar directamente al órgano diana, por lo que se requiere menos dosis, su respuesta es más rápida y hay menos efectos adversos

Comportamiento mecánico del hueso frente al estrés ocupacional : una visión desde la fisioterapia

Hablar del comportamiento mecánico del hueso frente al estrés ocupacional visto desde la fisioterapia, implica destacar tres aspectos que deben tomarse en cuenta al momento de reflexionar sobre cualquier área del conocimiento: • El primero implica que el lector reconozca que conocer puede generar un saber sistemático de la realidad, la cual siempre se encontrará sujeta al paradigma1 históricamente vigente. • El segundo supone que el movimiento corporal humano (objeto de estudio de la profesión) debe ser explorado desde la investigación, no sólo a la luz de las necesidades del momento, sino que debe generar líneas y grupos interdisciplinares que se enfoquen en áreas de interés social, como es el caso de la salud y el trabajo de las personas (interés primario de este texto). • El tercero, hace referencia a encontrar respuestas preventivas o por lo menos explicativas que den oportunidad a nuevas interpretaciones desde la fisioterapia al conocimiento de los marcadores de estrés ocupacional

Educación posgradual para fisioterapeutas en el área cardiopulmonar en Colombia

This paper presents the supply of postdegree programs in the cardiopulmonary area in Colombia in orden to show its state and sufficiency. Plans of formation, objectives, curricular approach, methodology and profile of performance are analyzed in terms of costs, duration, supply, location and research capabilities. Our results show problems in regard to supply as well as unanimous criteria and strategic alliances. There are no Gremial associations that favor both discussion and analysis about epidemiologist aspects of respiratory and cardiovascular diseases in Colombia there is necessity of professionals in this area with experience. Knowledge and appropiated skills in management, administration, laws, agreements and public policies that cover the affected population. Also, it is exposed that the Universities whit this programs require support and pursuit for professionals positioning both in national and international context.Methodology A descriptive study was carried out with a data collection made in a period between April-December of 2006. Cards were done and they allowed to review different aspects such as costs, occupational profile, duration, modality, methodology, practical component and evaluation in the offering universities of programs of postdegree in the cardiopulmonary area for physiotherapists. Later an analysis was made on curriculum, profiles, objectives, contents, professional competitions the areas of research.En este artículo se presenta la oferta de los programas de posgrados en el área cardiopulmonar en Colombia con el fin de mostrar el estado y la suficiencia de la misma. Se revisan los planes de formación, los objetivos, el enfoque curricular, la metodología y el perfil de desempeño; así mismo, en términos de costos, la duración, la oferta, la ubicación y la investigación. Los resultados muestran una posición difícil en cuanto a la oferta, unificación de criterios y las alianzas estratégicas; no existen asociaciones gremiales en el área que favorezcan espacios de discusión, reflexión y análisis del comportamiento epidemiológico de las enfermedades respiratorias y cardiovasculares en Colombia que permitan mostrar la urgencia de profesionales que respondan a esta situación y tengan pleno conocimiento y acción sobre la gestión, la administración, las leyes, los acuerdos y las políticas públicas que cubren la población afectada. Por último, se demuestra que las universidades que ofertan estos programas requieren más proyección y seguimiento en cuanto al posicionamiento de estos profesionales frente a las exigencias del entorno nacional y mundial. Metodología Se realizó un estudio descriptivo, con una recolección de datos en el período abril-diciembre de 2006; se diseñaron fichas que permitieran revisar diferentes aspectos, como costos, perfil ocupacional, duración, modalidad, metodología, componente práctico y evaluación en las universidades oferentes de programas de posgrado en el área cardiopulmonar para fisioterapeutas; posteriormente, se realizó un análisis sobre el currículo, los perfiles, los objetivos, los contenidos, las competencias profesionales y el área de investigación

Effects of microgravity on physical condition in astronauts. Is there a physiotherapeutic intervention?

La fisioterapia como el área del estudio del movimiento corporal humano ha abierto caminos en investigación en distintos ámbitos. Por ejemplo, en medicina aeroespacial se ha reportado que la exposición en el espacio durante una misión supone cambios fisiológicos a nivel cardiovascular, osteomuscular y neuromuscular en los astronautas debido a la exposición a microgravedad, se ha reportado que protocolos de actividad física y ejercicio pueden ser utilizados para la prevención y entrenamiento de astronautas mostrando efectossignificativos en la condición físicaPhysiotherapy as the area of ??study of human body movement has opened research paths in different fields. For example, in aerospace medicine it has been reported that exposure in space during a mission involves physiological changes at the cardiovascular, osteomuscular and neuromuscular levels in astronauts due to exposure to microgravity, it has been reported that physical activity and exercise protocols can be used for the prevention and training of astronauts showing significant effects on physical conditio

Oxigenoterapia

La oxigenoterapia es la modalidad terapéutica más recomendable para el tratamiento de deficiencias de ventilación/perfusión, intercambio de gases e hipoventilación; por tanto, para la Fisioterapia Cardiopulmonar es de significativa importancia conocer su soporte conceptual y aplicación. De acuerdo con lo anterior, se justifica la publicación del presente documento que hace una aproximación teórica de la oxigenoterapia, su definición, indicaciones, sistemas y formas de administración, prescripción, evaluación, cuidados generales y almacenamiento

Adherence to the recommendations in respiratory rehabilitation of the British Thoracic Society in patients with cystic fibrosis: a study of colombian physiotherapists

Con el objetivo de evaluar el cumplimiento de las recomendaciones en rehabilitación respiratoria (ReR), planteadas por la British Thoracic Society (BTS) en pacientes con fibrosis quística (FQ) se realizó un estudio transversal entre 224 fisioterapeutas colombianos para identificar el tipo de intervenciones y las características de los programas de ReR como componentes del cumplimiento de las guías clínicas basadas en la evidencia de la BTS. Un elevado porcentaje de profesionales respondieron “realizar siempre” intervenciones con alto nivel de evidencia (grado A) como: técnicas de higiene bronquial (54,0%) y ciclo activo de la respiración (35,3%). Se observaron también intervenciones con menor grado de recomendación (grado D) como: uso de solución salina hipertónica y broncodilatador para evitar el broncoespasmo (33,9%), y técnicas de terapia manual o ejercicios de movilidad torácica y resistida (38,4%) para corregir problemas posturales y respiratorios. En conclusión, se encontraron importantes discrepancias con las intervenciones y componentes sugeridos por BTS en pacientes con FQ.The aim was to evaluate compliance with the recommendations in respiratory rehabilitation (ReR), raised by the British Thoracic Society (BTS) in patients with cystic fibrosis. A cross-sectional study was conducted in 224 Colombian physiotherapists to identify interventions and components of ReR programs as recommended by the BTS. Interventions with high level of evidence (Grade A) such as: Bronchial Hygiene Therapy (54.0%), and Active Cycle of Breathing Techniques (35.3%) were identified. However, high percentage of physiotherapists practiced interventions with lower grade of recommendation (Grade D) such as: hypertonic saline and bronchodilator to prevent bronchospasm (33.9%), and using manual therapy techniques and thoracic mobility exercises (38.4%) to correct postural and breathing problems. In conclusions we confirm important differences in therapeutic assistant components of the ReR raised by the BTS for patients with cystic fibrosis

Aire. Apoyo Integral Respiratorio en Emergencias

El desarrollo de la formación académica en vía aérea difícil concluyó en el texto que se presenta ahora bajo el nombre de AIRE, Apoyo Integral Respiratorio en Emergencias. Este proyecto se inició hace 5 años con el objetivo de desarrollar un curso adquirieran las aptitudes y los conocimientos necesarios para el manejo básico y avanzado de la vía aérea del paciente urgente. Así mismo, respondió a la necesidad creciente de entrenamiento para el manejo avanzado de la vía aérea en el entorno de los servicios de urgencias intra y extra hospitalarias por parte de los médicos generales, especialistas en Medicina de Emergencias, Anestesia, Cirugía General, Medicina Interna, y de todo el personal relacionado con el cuidado del paciente crítico. Fue así como un grupo de conformado por dos emergeciólogos, cuatro residentes de Medicina de Emergencias y una terapeuta respiratoria comenzamos a convertirnos en facilitadores para el aprendizaje de este difícil tema

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research