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Abstract Background: Working memory-based spatial cognition has attracted the attention of the scientific community in navigation and reorientation projects. The dominant approach considers that spontaneous spatial navigation behavior is based merely on environmental geometry (built and natural environmental objects). In this domain, DCD (Developmental Coordination Disorder) motor skill orientation problems have been frequently associated with poor visuospatial cognition, while immersive VR environments encourage more repetition, allowing for faster motor skill development and recovery. Objective: This pilot study tested the functionality of an immersive VR environment with environmental geometry (rectangular arena rich in symmetry) and featural landmark cues (striped wall, flora) as a route-learning tool for children with motor skill disorders. Methods: Forty DCD children aged 5 to 8 years (20 boys and 20 girls); five (5) 3D reality modeling setups with orthogonality, symmetry, and striped walls as design parameters; and trial walk-through coordination exercises using a predefined visual pathway with different motor control conditions (daylight, darkness). Participants' path completion rate, path completion time, and walk-through satisfaction were recorded as route-learning performance variables and analyzed statistically. Results/findings: DCD children's spatial orientation was statistically shown to be more stable and robust (in path completion rates, termination time, and walk-through level of satisfaction) in a virtual 3D environment rich in orthogonality, symmetry, and featural cues as landmarks. In this compound environmental geometry setup, training functionality and immersive learning performance enjoyed an 8.16% better path completion rate, a 12.37% reduction in path completion time, and 32.10% more walk-through satisfaction than reality modeling setups poor in geometry and landmarks. The effectiveness and robustness were validated statistically. Conclusion: Children with motor skill difficulties train and learn better in virtual 3D environments that are rich in orthogonality, symmetry, and featural landmark cues.
Resumen Antecedentes: La cognición espacial basada en la memoria de trabajo ha atraído la atención de la comunidad científica en proyectos de navegación y reorientación. El enfoque dominante considera que el comportamiento espontáneo de navegación espacial se basa meramente en la geometría ambiental (objetos ambientales construidos y naturales). En este ámbito, los problemas de orientación de las habilidades motoras del TDC (Trastorno del Desarrollo de la Coordinación) se han asociado con frecuencia a una cognición visoespacial deficiente, mientras que los entornos de RV (Realidad Virtual) inmersivos fomentan una mayor repetición, lo que permite un desarrollo y una recuperación más rápidos de las habilidades motoras. Objetivo: Este estudio piloto probó la funcionalidad de un entorno de RV inmersiva con geometría ambiental (arena rectangular rica en simetría) y señales de puntos de referencia característicos (pared rayada, flora) como herramienta de aprendizaje de rutas para niños con trastornos de la habilidad motora. Métodos: Cuarenta niños con TDC de entre 5 y 8 años (20 niños y 20 niñas); cinco (5) configuraciones de modelado de realidad 3D con ortogonalidad, simetría y paredes rayadas como parámetros de diseño; y ejercicios de coordinación de recorrido de prueba utilizando una ruta visual predefinida con diferentes condiciones de control motor (luz diurna, oscuridad). Se registraron la tasa de finalización del recorrido, el tiempo de finalización del recorrido y el grado de satisfacción de los participantes como variables de rendimiento del aprendizaje de recorridos y se analizaron estadísticamente. Resultados: Se demostró estadísticamente que la orientación espacial de los niños con TDC era más estable y robusta (en tasas de finalización del camino, tiempo de finalización y nivel de satisfacción del recorrido) en un entorno 3D virtual rico en ortogonalidad, simetría y señales de características como puntos de referencia. En esta configuración de geometría ambiental compuesta, la funcionalidad del entrenamiento y el rendimiento del aprendizaje inmersivo disfrutaron de un 8,16% más de tasa de finalización de ruta, una reducción del 12,37% en el tiempo de finalización de ruta y un 32,10% más de satisfacción de recorrido que las configuraciones de modelado de realidad pobres en geometría y puntos de referencia. La eficacia y la solidez se validaron estadísticamente. Conclusiones: Los niños con dificultades motrices entrenan y aprenden mejor en entornos virtuales 3D ricos en ortogonalidad, simetría y puntos de referencia característicos.
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Resumen Objetivo: El objetivo del estudio es caracterizar psicométricamente los datos de empatía y sus dimensiones, así como determinar la distribución empática entre las áreas académicas en el proceso de formación de estudiantes de pregrado de enfermería. Métodos: Este es un estudio comparativo, no experimental y transversal. La muestra estudiada fue de 365 estudiantes de enfermería de ambos sexos pertenecientes a la Facultad de Enfermería de la Universidad Veracruzana, México. El total de la población fue de 425 estudiantes y la muestra constituyó el 85,88% del total de estudiantes (mayo a julio de 2022). Se estudiaron las propiedades psicométricas de la escala de Empatía para Profesionales de la Salud, versión estudiantes (fiabilidad, validez de constructo e invarianza del modelo). Para describir y comparar los grupos se utilizaron estadísticos descriptivos, análisis de varianza y gráficos de las medias con barras que representaban el intervalo de confianza al 95%. Resultados: La medida de empatía alcanza coeficientes de fiabilidad satisfactorios y presenta adecuados indicadores de validez de constructo, resultando una medida invariante según área académica y sexo. Se encontró la existencia de déficits en algunas de las dimensiones de empatía. Conclusión: El análisis psicométrico (modelo de dimensiones subyacentes e invarianza), previa a la estimación de los parámetros de la empatía, constituye una necesitad metodológica que garantiza teóricamente la estimación de los niveles de empatía y de la comparación entre grupos. La distribución de los niveles de empatía entre las áreas académicas se caracterizó por un déficit en las dimensiones cuidado con compasión y "caminar en los zapatos del paciente".
Abstract Aim: The objective of the study is to psychometrically characterize the empathy data and its dimensions, as well as to determine the empathic distribution among the academic areas in the process of training undergraduate nursing students. Methods: This is a comparative, non-experimental, cross-sectional study. The studied sample consisted of 365 nursing students of both sexes belonging to the Faculty of Nursing of the Universidad Veracruzana, México. The total population was 425 students and the sample constituted 85.88% of the total number of students (May to July 2022). The psychometric properties of the Empathy Scale for Health Professionals, student version (reliability, construct validity, and model invariance) were studied. To describe and compare the groups, descriptive statistics, analysis of variance, and graphs of the means with bars -representing the 95% confidence interval- were used. Results: The empathy measure reaches satisfactory reliability coefficients and it presents adequate indicators of construct validity indicators, resulting in an invariant measure according to academic area and sex. The existence of deficits in some of the dimensions of empathy was found. Conclusion: The psychometric analysis (model of underlying dimensions and invariance), prior to the estimation of the empathy parameters, constitutes a methodological necessity that theoretically guarantees the estimation of the empathy levels and the comparison between groups. The distribution of empathy levels between academic areas was characterized by a deficit in the dimensions of compassionate care and "walking in the patient's shoes".
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Abstract Introduction: In recent decades, the level of skiing performance in Russia has decreased significantly. This has necessitated problems with the preparation of athletes for competitions and the training process. Objective: To analyze the effects of simulation training tools on the physical condition of ski racers aged 13-14 years. Methods: Quasi-experimental, non-randomized study. 40 cross-country skiers aged 13-14 years belonging to the Korshik Village sports school (Russia) were assigned to a control (n = 20) and experimental (n = 20) group. Classes in the control group were conducted according to the usual training plan and in the experimental group simulation exercises were used. The control tests included pull-ups, squats, two-legged long jump, simulated 100-meter climbing and a 500-meter running test. Results: The control group showed no significant improvements (p > 0.05), while the experimental group reported significant improvements in pull-ups (22.2%; p< 0.05), squat (5.9%; p< 0.05), two-legged long jump (6.8%; p< 0.05), 100-meter climbing simulation (7.8%; p< 0.05) and 500-meter run (4.2 %, p <0.05). Conclusion: If, in the preparatory period, a series of simulation exercises are included in the training program for skiers aged 13-14 years, the level of physical fitness of athletes will improve significantly.
Resumen Introducción: En las últimas décadas, el nivel de rendimiento del esquí en Rusia ha disminuido significativamente. Esto plantea nuevos desafíos en la preparación de los atletas para las competiciones y el proceso de entrenamiento. Objetivo: Analizar los efectos de las herramientas de entrenamiento por simulación sobre la condición física de corredores de esquí de entre 13 y 14 años. Métodos: Estudio cuasiexperimental, no aleatorizado. 40 esquiadores de fondo de entre 13 y 14 años pertenecientes a la escuela deportiva Korshik Village (Rusia) fueron asignados a un grupo control (n=20) y experimental (n=20). Las clases en el grupo de control se llevaron a cabo según el plan de entrenamiento habitual y en el grupo experimental se utilizaron ejercicios de simulación. Las pruebas de control incluyen dominadas, sentadillas, salto de longitud con dos piernas, escalada simulada de 100 metros y una prueba de carrera de 500 metros. Resultados: El grupo control no presentó mejoras significativas (p>0,05), mientras que el grupo experimental reportó mejoras significativas en dominadas (22,2%; p<0,05), sentadilla (5,9%; p<0,05), salto de longitud a dos piernas (6,8%; p<0,05), simulación de escalada de 100 metros (7,8%; p<0,05) y carrera de 500 metros (4,2%; p<0,05). Conclusión: Si en el periodo preparatorio se incluye una serie de ejercicios de simulación en el programa de entrenamiento para esquiadores de 13-14 años, el nivel de condición física de los deportistas mejorará significativamente.
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Este estudo buscou avaliar as contribuições de um treinamento parental híbrido realizado com oito mães de crianças pré-escolares com transtorno do espectro do autismo baseado na ciência da análise do comportamento aplicada para a redução do estresse parental. Foi realizado a construção e implementação do treinamento parental híbrido. A amostra foi dividida em grupo tratamento e controle. Em termos de análise de dados, foram feitas comparações do nível de estresse no período pré/pós-intervenção, assim como a análise de uma prática direta com a criança de forma presencial com o grupo tratamento. Os resultados obtidos demonstraram que as mães do grupo tratamento reagiram positivamente com as vídeos e materiais apresentados. No entanto, não foi observado diferenças estatísticas significativas para sugerir a redução do nível de estresse entre os dois grupos. As limitações do estudo foram o tamanho reduzido da amostra e o fato das crianças de ambos os grupos continuarem recebendo o tratamento em terapia intensiva durante a aplicação do treinamento parental.
Este estudio buscó evaluar los aportes de un entrenamiento parental híbrido realizado con ocho madres de niños preescolares con trastorno del espectro autista basado en la ciencia del análisis aplicado de la conducta para la reducción del estrés parental. Se llevó a cabo la construcción e implementación de un entrenamiento parental híbrido. Se dividió la muestra en grupo de tratamiento y control, y se realizaron comparaciones del nivel de estrés en el período pre/postintervención, así como el análisis de la práctica directa con el niño en un cara a cara con el grupo de tratamiento. Los resultados obtenidos demuestran que las madres del grupo de tratamiento reaccionaron positivamente a los videos y materiales presentados; sin embargo, no se observaron diferencias estadísticas significativas que sugieran una reducción en el nivel de estrés entre los dos grupos. Las limitaciones del estudio fueron el pequeño tamaño de la muestra y el hecho de que los niños de ambos grupos continuaron recibiendo tratamiento de terapia intensiva durante la implementación de la capacitación de los padres.
This study sought to evaluate the contributions of a hybrid parental training carried out with eight mothers of preschool children with autism spectrum disorder, based on the science of applied behavioral analysis for reducing parental stress. The hybrid parental training was constructed and implemented by the researchers. The sample was divided into two groups: a Treatment Group and a Control Group. In the data analysis, comparisons were made of the levels of stress pre- and post-intervention and for the treatment group, direct practice with the child in a face-to-face environment was also analyzed. The results showed that the mothers in the treatment group reacted positively to the video and materials presented; however, no significant statistical differences were found that would suggest a reduction in stress levels between the two groups as a result of the training given. The limitations of the study were its small sample size and the fact that the children in both groups continued to receive intensive therapy treatment during the application of the parental training.
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AIMS: This systematic review aimed to assess the impact of oral health training for caregivers of individuals with disabilities. MATERIALS AND METHODS: A systematic review was conducted using five electronic databases: Medline (PubMed), SciELO, Web of Science, LILACS, and CAFe, adhering to PRISMA guidelines. The PICO strategy was defined as follows: Participants: caregivers of individuals with disabilities; Intervention: training or education in oral health for caregivers; Control: no caregiver training; and Outcomes: evaluating whether oral health training for caregivers improves the oral health of people with disabilities. The study aimed to address the research question: "What is the impact of oral health training for caregivers of individuals with disabilities?" The study was preregistered in PROSPERO (CRD42023416760). RESULTS: A total of 14 studies were included, with trained caregivers being either staff members or parents, and various disabilities reported, with cerebral palsy being the most prevalent. Caregiver training methods varied, such as instructions on the importance of oral health care, supervised oral hygiene, and demonstration of toothbrushing techniques. Overall, the intervention groups showed an improvement in measures such as to the Gingival Index, Plaque Index, Simplified Oral Hygiene Index, and Gingival Bleeding Index on upon probing. Additionally, improvements were observed in the quality, frequency, and duration of toothbrushing among intervention groups. CONCLUSION: The findings suggest that oral health training for caregivers has a positive impact on the oral health of individuals with disabilities, potentially leading to better oral health outcomes.
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Background: Fibromyalgia (FM) is characterized by widespread chronic pain. Although pain is the main symptom, approximately 90% of patients have depression. This study aimed to analyze the effects of Resistance Training (RT) with low and high intensity on depression in patients with FM. Methods: Thirty-eight women with FM and 31 healthy women were allocated to the low-intensity, high-intensity, preferred-intensity, and control groups. The patients underwent 8 weeks of supervised RT, with two sessions per week of approximately 1 h. The low-intensity resistance training group (LIRT) performed two sets of 12 maximum repetitions. The high-intensity resistance training group (HIRT) performed four sets with six maximum repetitions, and the preferred intensity group (PI) performed three sets, with eight to 12 repetitions, according to the patient's tolerance. The healthy control group did not perform any type of exercise. Depression was assessed using the Beck depression inventory before the start of the intervention, after 4 and 8 weeks. Results: FM patients have higher levels of depression than women without the disease. After 4 weeks, there was a difference in depressive symptoms between the HIRT and LIRT (p = 0.048), and the PI and LIRT (p = 0.048). Conclusion: Prescribing RT with low or high intensity did not significantly reduce depression in patients with FM after 8 weeks, however, analyses between groups after 4 weeks indicated that low-intensity training is more effective than high-intensity training. The prescription of RT exercise to FM could vary among low, high, and preferred intensity, following the patient's tolerance for pain. Clinical trial registration: https://ensaiosclinicos.gov.br/rg/RBR-74pcmw, RBR-74pcmw.
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Tutoria , Resiliência Psicológica , Humanos , Tutoria/métodos , Mentores , Pesquisa Biomédica/educação , Saúde HolísticaRESUMO
Training is instrumental in identifying and selecting cattle that exhibit greater cooperation with experimental conditions required in flow respirometry assays, like restraint and the use of a valved facial mask. In our study, a tailored training protocol for Nellore cattle facilitated their participation in flow respirometry assays with a valved facial mask. Over 127 days, 30 entire Nellore males, weighing 450 ± 25 kg and averaging 32 ± 2 months, underwent training from May to September 2022. The regimen involved gradually altering the animals' environment and providing positive reinforcement, divided into three phases. Physiological and behavioral responses to containment routines and facial mask use were meticulously assessed. Principal component analyses revealed dissimilarity patterns among the animals. Animals classified as less reactive showed increased acceptance of handling, reduced reactions to weighing, and greater tolerance of the facial mask. In the final phase, the least reactive animals tolerated wearing a valved mask for extended periods without notable changes in respiratory rate. The training protocol effectively identified and selected Nellore cattle displaying enhanced cooperation with restraint and mask use during flow respirometry assays, without apparent behavioral or physiological alterations.
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CONTEXT: Energy homeostasis is a primary factor for the survival of mammals. Many tissues and organs, among which is the liver, keep this homeostasis in varied circumstances, including caloric restriction (CR) and physical activity. OBJECTIVE: This study investigated glucose metabolism using the following groups of eight-week-old male Swiss mice: CS, sedentary and fed freely; RS, sedentary and RT, trained, both under 30% CR (n = 20-23 per group). RESULTS: Organs and fat depots of groups RS and RT were similar to CS, although body weight was lower. CR did not impair training performance nor affected systemic or hepatic glucose metabolism. Training combined with CR (group RT) improved in vivo glucose tolerance and did not affect liver gluconeogenesis. CONCLUSIONS: The mice tolerated the prolonged moderate CR without impairment of their well-being, glucose homeostasis, and resistance training performance. But the higher liver gluconeogenic efficiency previously demonstrated using this training protocol in mice was not evidenced under CR.
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Pulmonary arterial hypertension (PAH) is a disease that affects millions of people worldwide. Besides the effects on the lungs and heart, PAH can affect other organs, including the liver, kidneys, brain, glands, and testis. This study aimed to evaluate the impact of PAH and physical resistance training (RT), a complementary treatment for hypertension, on epididymis morphology and function and sperm parameters. Wistar rats were divided into four experimental groups (n = 8/ group): sedentary control, sedentary PAH, RT control, and RT + PAH. PAH was induced using monocrotaline injections on Day 1 and 7 of the experiment. Sixteen rats from RT groups underwent RT training for 30 days, while rats from sedentary groups did not exercise. The epididymis was processed and analyzed using microscopic, biochemical, and functional approaches. Sperm were harvested from the cauda epididymis and evaluated for morphology and motility. Our results showed that PAH compromised the epididymis antioxidant defense system and reduced NO levels, leading to an imbalance in the organ's mineral content. These alterations affected the epididymis morphology and reduced the sperm transit time in the proximal epididymis, resulting in an increase in abnormal sperm morphology in the cauda region. Unfortunately, RT was not a good therapy against the PAH effect on the epididymis. PAH negatively affected epididymis functions with consequences to male gametes. Dysfunctions in the post-testicular environment may lead to male infertility due to the disturbance of spermatozoa fecundity.
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OBJECTIVES: Metacognitive training (MCT) for psychosis is a group intervention that combines cognitive-behavioural therapy and psychoeducation. It has proven efficacy in reducing psychotic symptoms and correcting cognitive biases implicated in the development and maintenance of psychotic symptoms. However, other outcomes, such as patient satisfaction with the intervention, have not been well studied despite their importance for adherence and overall success. A systematic review of randomized clinical trials was conducted to assess satisfaction with MCT among adults with psychotic spectrum disorders. METHODS: The search was conducted in Ovid Embase, Ovid MEDLINE, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL). PRISMA guidelines and the Cochrane Risk of Bias Tool were followed, and certainty of evidence was ascertained using the Grading of Recommendations Assessment, Development and Evaluation framework. The study is registered with PROSPERO (CRD42023418097). RESULTS: Patient satisfaction was considered the primary outcome in 3 of the 10 studies reviewed. Four studies compared MCT with other psychosocial interventions (a newspaper discussion group, cognitive remediation and supportive therapy), two of which found significantly higher satisfaction with MCT. A high percentage of all patients found MCT comprehensible and considered it an important part of their treatment; they would recommend the training to others and found the group setting advantageous. Most participants expressed high subjective satisfaction or acceptance of MCT. CONCLUSIONS: The authors found evidence that MCT may be associated with high levels of satisfaction in clinical trials whose main objective is to assess patient satisfaction, but more research is needed to consolidate the findings, especially for the extended version of MCT.
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Terapia Cognitivo-Comportamental , Metacognição , Satisfação do Paciente , Transtornos Psicóticos , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Transtornos Psicóticos/terapia , Transtornos Psicóticos/psicologia , Satisfação do Paciente/estatística & dados numéricos , Terapia Cognitivo-Comportamental/métodos , Psicoterapia de Grupo/métodosRESUMO
BACKGROUND: Learning styles are biological and developmental configurations of personal characteristics that make the same teaching method effective for some and ineffective for others. Studies support a relationship between learning style and career choices in medicine, resulting in learning style patterns being observed in different residency programs, including in general surgery, from medical school to the last stages of training. The methodologies, populations, and contexts of the few studies pertinent to the matter are very different from one another, and a scoping review on this theme will enhance and organize what is already known. OBJECTIVE: The goal of this study is to identify and map out data from studies on the learning styles of medical students, surgical residents, medical staff, and surgical teachers. METHODS: The review will consider studies on the learning styles of medical students in a clinical cycle or internship, surgical residents with no restriction on year of residency, medical staff in general surgery, or general surgery's medical faculty. Primary studies published in English, with no specific time frame, will be considered. The search will be carried out in four databases, and reference lists will be searched for additional studies. Duplicates will be removed, and two independent reviewers will screen the titles, abstracts, and full texts of the selected studies. Data collection will be performed using a tool developed by the researchers. A results summary will be presented with figures, narratives, and tables. A quantitative and qualitative analysis will be carried out and further results will be shared. RESULTS: The search was funded on September 25, 2023. Data collection was performed in the two following months. Of the 213 articles found, 135 were excluded due to duplication. The remaining 78 articles will have their titles and abstracts analyzed by three of the researchers independently to select those that meet the eligibility criteria. This data is expected to be published in the first semester of 2025. CONCLUSIONS: Conducting a scoping review is the best way to map what is known about a subject. Understanding how students, residents, staff, and even teachers prefer to learn surgery is key to staying up to date and knowing how to best educate those pursuing a surgical career. TRIAL REGISTRATION: Open Science Framework 75ku4; https://osf.io/75ku4. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57229.
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Cirurgia Geral , Internato e Residência , Aprendizagem , Estudantes de Medicina , Humanos , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Cirurgia Geral/educação , Corpo Clínico/psicologia , Corpo Clínico/educação , Docentes de Medicina/psicologiaRESUMO
Introducción. La formación integral de los residentes excede el conocimiento teórico y la técnica operatoria. Frente a la complejidad de la cirugía moderna, su incertidumbre y dinamismo, es necesario redefinir la comprensión de la educación quirúrgica y promover capacidades adaptativas en los futuros cirujanos para manejar efectivamente el entorno. Estos aspectos se refieren a la experticia adaptativa. Métodos. La presente revisión narrativa propone una definición de la educación quirúrgica con énfasis en la experticia adaptativa, y un enfoque para su adopción en la práctica. Resultados. Con base en la literatura disponible, la educación quirúrgica representa un proceso dinámico que se sitúa en la intersección de la complejidad de la cultura quirúrgica, del aprendizaje en el sitio de trabajo y de la calidad en el cuidado de la salud, dirigido a la formación de capacidades cognitivas, manuales y adaptativas en el futuro cirujano, que le permitan proveer cuidado de alto valor en un sistema de trabajo colectivo, mientras se fortalece su identidad profesional. La experticia adaptativa del residente es una capacidad fundamental para maximizar su desempeño frente a estas características de la educación quirúrgica. En la literatura disponible se encuentran seis estrategias para fortalecer esta capacidad. Conclusión. La experticia adaptativa es una capacidad esperada y necesaria en el médico residente de cirugía, para hacer frente a la complejidad de la educación quirúrgica. Existen estrategias prácticas que pueden ayudar a fortalecerla, las cuales deben ser evaluadas en nuevos estudios.
Introduction. The comprehensive training of residents exceeds theoretical knowledge and operative technique. Faced with the complexity of modern surgery, its uncertainty and dynamism, it is necessary to redefine the understanding of surgical education and promote adaptive capabilities in future surgeons for the effective management of the environment. These aspects refer to adaptive expertise. Methods. The present narrative review proposes a definition of surgical education with an emphasis on adaptive expertise, and an approach for its adoption in practice. Results. Based on the available literature, surgical education represents a dynamic process that is situated at the intersection of the complexity of surgical culture, learning in the workplace, and quality in health care, aimed at training of cognitive, manual, and adaptive capacities in the future surgeon, which allow them to provide high-value care in a collective work system, while strengthening their professional identity. Resident's adaptive expertise is a fundamental capacity to maximize his or her performance in the face of these characteristics of surgical education. In the available literature there are six strategies to strengthen this capacity. Conclusion. Adaptive expertise is an expected and necessary capacity in the surgical resident to deal with the complexity of surgical education. There are practical strategies that can help strengthen it, which must be evaluated in new studies.
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Humanos , Educação de Pós-Graduação em Medicina , Aprendizado Profundo , Competência Profissional , Cirurgia Geral , Educação Vocacional , MetacogniçãoRESUMO
Abstract Surgery is a key pillar in medical care, and both the surgical as well as the anesthetic components are essential within the health systems in countries of all levels of development. Every year, close to 230 million surgical procedures are performed worldwide, with pediatric surgery being representative, as around 85% of children require a surgical procedure. However, the issue of education and training of the people involved in pediatric surgery who can provide safe surgical and anesthetic care in medium and low income countries has been absent from the global health debate. The development of anesthesia in pediatrics faces many challenges: it is a relatively new specialty, it has to deal with clinical challenges associated with anatomical, physiological, psychological and procedure-related differences, while it faces the reality of few training opportunities which results in a limited number of duly trained and qualified specialists in pediatric anesthesiology. In Latin America, the possibility of applying to a specialization in pediatric anesthesia is limited. In particular in Colombia it has not been possible to establish a pediatric anesthesia subspecialty, creating the need to promote formal and informal training in this discipline in order to ensure that safe, good quality anesthetic care is provided to children. This article describes the development of pediatric anesthesia training in the world and in Colombia, highlighting the relationship between the incidence of anesthetic complications and the need for training in this discipline.
Resumen La cirugía es una parte indispensable en la atención médica, siendo el componente quirúrgico y el anestésico fundamentales dentro del sistema de salud en países de todos los niveles de desarrollo. Anualmente, se realizan alrededor de 230 millones de procedimientos quirúrgicos en todo el mundo, siendo la cirugía pediátrica un porcentaje, ya que alrededor del 85 % de los niños requiere un procedimiento quirúrgico; sin embargo, la prestación de servicios quirúrgicos y anestésicos seguros desde la formación y entrenamiento de los actores involucrados en la atención quirúrgica infantil en países de medianos y bajos ingresos ha estado ausente del discurso de salud global. El desarrollo del campo de la anestesia en pediatría enfrenta múltiples retos: es una especialidad relativamente nueva, presenta desafíos clínicos relacionados con las diferencias anatómicas, fisiológicas, psicológicas y procedimentales, así como existen pocas oportunidades de entrenamiento con el consecuente número limitado de especialistas en anestesiología pediátrica capacitados y calificados. Para América latina, las posibilidades de aplicar a una especialización en anestesiología pediátrica son limitadas y específicamente para Colombia no ha sido posible crear la subespecialidad de anestesiología pediátrica, por lo que se debe fomentar la formación formal e informal en esta disciplina, con el fin de ofrecer una atención anestésica segura y con calidad para los niños. Este artículo hace un recuento del desarrollo de la formación en anestesiología pediátrica en el mundo y en Colombia, visibilizando la relación con la incidencia de complicaciones anestésicas y la necesidad de formación en esta disciplina.
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Cisplatin (CDDP) is an antineoplastic drug whose adverse effects include hepatotoxicity. The inflammatory process is crucial in the progression of liver injuries. Exercise is known for its anti-inflammatory effects, but the influence of different training modalities on hepatoprotection is still unclear. This study aims to compare the impacts between preconditioning with high-intensity interval training (HIIT) and traditional continuous training of low (LT) and moderate (MT) intensities on inflammatory markers in Wistar female rats with CDDP-induced hepatotoxicity. Thirty-five rats were divided into five groups: control and sedentary (C + Sed), treated with CDDP and sedentary (CDDP + Sed), treated with CDDP and subjected to LT (CDDP + LT), treated with CDDP and subjected to MT (CDDP + MT), and treated with CDDP and subjected to HIIT (CDDP + HIIT). The training protocols consisted of treadmill running for 8 weeks before CDDP treatment. The rats were euthanized 7 days after the treatment. Liver samples were collected to evaluate the expression of various inflammatory markers and types of macrophages. Our results indicated that HIIT was the only protocol to prevent the increase in all analyzed pro-inflammatory cytokines and reduce the number of ED-1-positive cells, attenuating the TLR4/NF-κB signaling pathway in the liver. Additionally, HIIT increased the anti-inflammatory cytokine IL-10 and regulated M1/M2 macrophage polarization. Thus, this study suggests that preconditioning with HIIT is more effective in promoting hepatoprotective effects than LT and MT, regulating inflammatory markers through modulation of the TLR4/NF-κB signaling pathway and M2 macrophage polarization in the hepatic tissue of female rats treated with CDDP.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Cisplatino , Treinamento Intervalado de Alta Intensidade , Macrófagos , NF-kappa B , Condicionamento Físico Animal , Transdução de Sinais , Receptor 4 Toll-Like , Animais , Feminino , Ratos , Antineoplásicos , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/patologia , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Cisplatino/efeitos adversos , Cisplatino/toxicidade , Treinamento Intervalado de Alta Intensidade/métodos , Inflamação/metabolismo , Fígado/metabolismo , Fígado/efeitos dos fármacos , Fígado/patologia , Macrófagos/metabolismo , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , NF-kappa B/metabolismo , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Receptor 4 Toll-Like/metabolismoRESUMO
Dietary sodium restriction increases plasma triglycerides (TG) and total cholesterol (TC) concentrations as well as causing insulin resistance and stimulation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system. Stimulation of the angiotensin II type-1 receptor (AT1) is associated with insulin resistance, inflammation, and the inhibition of adipogenesis. The current study investigated whether aerobic exercise training (AET) mitigates or inhibits the adverse effects of dietary sodium restriction on adiposity, inflammation, and insulin sensitivity in periepididymal adipose tissue. LDL receptor knockout mice were fed either a normal-sodium (NS; 1.27% NaCl) or a low-sodium (LS; 0.15% NaCl) diet and were either subjected to AET for 90 days or kept sedentary. Body mass, blood pressure (BP), hematocrit, plasma TC, TG, glucose and 24-hour urinary sodium (UNa) concentrations, insulin sensitivity, lipoprotein profile, histopathological analyses, and gene and protein expression were determined. The results were evaluated using two-way ANOVA. Differences were not observed in BP, hematocrit, diet consumption, and TC. The LS diet was found to enhance body mass, insulin resistance, plasma glucose, TG, LDL-C, and VLDL-TG and reduce UNa, HDL-C, and HDL-TG, showing a pro-atherogenic lipid profile. In periepididymal adipose tissue, the LS diet increased tissue mass, TG, TC, AT1 receptor, pro-inflammatory macro-phages contents, and the area of adipocytes; contrarily, the LS diet decreased anti-inflammatory macrophages, protein contents and the transcription of genes related to insulin sensitivity. The AET prevented insulin resistance, but did not protect against dyslipidemia, adipose tissue pro-inflammatory profile, increased tissue mass, AT1 receptor expression, TG, and TC induced by the LS diet.
Assuntos
Adiposidade , Dieta Hipossódica , Inflamação , Resistência à Insulina , Condicionamento Físico Animal , Animais , Camundongos , Inflamação/metabolismo , Inflamação/prevenção & controle , Masculino , Camundongos Knockout , Gordura Intra-Abdominal/metabolismo , Receptores de LDL/genética , Receptores de LDL/metabolismoRESUMO
BACKGROUND: This study examines whether creatine supplementation combined with strength training mitigates muscle mass loss in women during early rehabilitation post-bariatric surgery, as its effectiveness remains untested in this context. METHODS: Fifteen women (37.8 ± 9.6 years; BMI, 38.8 ± 5.6 kg/m2) completed the intervention (creatine group = 7; placebo group = 8). Both groups followed a strength training program three times a week for 8 weeks. The dosage for both the creatine and placebo was 8 g prior to each exercise session. Body weight, skeletal muscle mass, fat mass, handgrip strength, and physical activity levels were measured before and after the intervention. RESULTS: The creatine group showed a reduction of 9.5 ± 1.5 kg in body weight, with a 0.72 ± 0.6 kg decrease in muscle mass and an 8.64 ± 1.2 kg reduction in fat mass. The placebo group had a reduction of 9.6 ± 3.5 kg in body weight, with a 0.6 ± 1.2 kg decrease in muscle mass and an 8.88 ± 3.2 kg reduction in fat mass, without significant differences between groups (p > 0.05). CONCLUSION: The pre-session strength exercise training creatine supplementation is not superior to placebo regarding body weight and fat mass losses and the attenuation of muscle mass loss during the first weeks of rehabilitation following bariatric surgery.
Assuntos
Cirurgia Bariátrica , Creatina , Suplementos Nutricionais , Músculo Esquelético , Treinamento Resistido , Humanos , Feminino , Creatina/administração & dosagem , Projetos Piloto , Adulto , Treinamento Resistido/métodos , Músculo Esquelético/efeitos dos fármacos , Redução de Peso , Obesidade Mórbida/cirurgia , Força da Mão , Pessoa de Meia-Idade , Força Muscular/fisiologia , Força Muscular/efeitos dos fármacosRESUMO
Systematic reviews and meta-analyses support the benefits of inspiratory muscle training (IMT) for sports and clinical populations. A typical application of "standalone" IMT intervention consists of breathing against an inspiratory load (IRL), twice daily, for five to seven days per week, for four to twelve weeks. However, the application of IRL during aerobic exercise is often seen in a training routine of sports and rehabilitation centres with noevidencebased guide. In this Current Opinion, we will revisit putative mechanisms underlying the established benefits of "standalone" IMT to support our contention that IMT need not and should not be used during aerobic exercise.