Heart Rate Variability Changes From Traditional vs. Ultra-Short-Term Recordings in Relation to Preseason Training Load and Performance in Futsal Players

Nakamura, FY, Antunes, P, Nunes, C, Costa, JA, Esco, MR, and Travassos, B. Heart rate variability changes from traditional vs. ultra-short-term recordings in relation to preseason training load and performance in futsal players. J Strength Cond Res 34(10): 2974-2981, 2020-The aims of this study were to analyze heart rate variability (HRV) changes in futsal players during preseason training using both "criterion" (10-minute) and ultra-shortened (2-minute) measures, and to determine whether they were related to changes in the Yo-Yo Intermittent Recovery Test, level 1 (Yo-Yo IR1) performance and accumulated training load (TL). Eleven male competitive futsal players (age = 25.19 ± 4.70 years; body mass = 73.15 ± 11.70 kg; and height = 176.90 ± 5.01 cm) volunteered for the study. Data collection took place during the first to the fourth weeks of preseason training. Training load was monitored with session ratings of perceived exertion. The total distance (TD) covered during the Yo-Yo IR1 was recorded during week 1 and week 4. Heart rate variability was measured through the log-transformed root mean square of successive normal-to-normal interval differences using the ultra-short analysis, with its weekly mean (lnRMSSDM) and coefficient of variation (lnRMSSDCV) recorded, and by means of the criterion method (weeks 1 and 4). lnRMSSDM was likely higher at week 4 compared with week 1 using both criterion and ultra-short recordings. Moderate-to-large correlations were found between changes in the lnRMSSDM and lnRMSSDCV values and changes in TL and TD (r values ranged from -0.48 to 0.65). Changes in ultra-short HRV measures (i.e., increase in lnRMSSDM and decrease in lnRMSSDCV) during futsal preseason were associated with increased performance. The players who accumulated higher perceived TLs displayed smaller improvements in the Yo-Yo IR1 performance and HRV.

Teaching young consumers in Europe: a multicentre qualitative needs assessment with educators on food hygiene and food safety

AIM

Foodborne illnesses have a significant global burden and can be life-threatening, with higher risk in vulnerable groups such as children. SafeConsume is an EU-funded, transdisciplinary project aiming to improve consumers' food safety behaviour. Developing educational resources on food safety for use in schools has potential to improve teaching of our young consumers. The aim of this study was to explore school educators' attitudes, behaviours and knowledge towards food hygiene, safety and education.

METHODS

Focus groups and interviews in England, France, Portugal and Hungary explored educator knowledge, skills, intentions and beliefs around educating young people (11-18 years) about food safety. Data were analysed using NVivo and emerging themes were applied to the Theoretical Domains Framework.

RESULTS

A total of 48 educators participated. Knowledge, confidence and skills to teach food safety to young people varied depending on background and training. Educators reported they had a role to teach food safety to young people, were positive about delivering education and optimistic they could improve students' food safety behaviour. Barriers to teaching included lack of national curriculum coverage, limited time and money, and lack of facilities. Educators reported that social influences (family, celebrity chefs, public health campaigns and social media) were important opportunities to improve young peoples' awareness of food safety and consequences of foodborne illness.

CONCLUSION

Educator food safety expertise varied; training could help to optimise educator knowledge, confidence and skills. Ministries of Health and Education need encouragement to get food safety incorporated further into school curricula across Europe, so schools will be motivated to prioritise these topics.

Modeling Fitness Variable Responses to Training in Prepubescent Children

Alves, AR, Marta, C, Neiva, HP, Nunes, C, Izquierdo, M, and Marques, MC. Modeling fitness variable responses to training in prepubescent children. J Strength Cond Res 34(8): 2352-2359, 2020-The aim of this study was to determine strength and oxygen uptake (V[Combining Dot Above]O2max) performances according to different training program intervention design with 8-week duration in prepubescent children through a multiple linear regression models. Two hundred forty-five healthy prepubescent children (aged 10.9 ± 0.5 years) were randomly assigned to a specific training program (strength training only-S; aerobic training only-A; intrasession aerobic and strength training-AS; intrasession strength and aerobic training-SA; or concurrent training performed in different sessions-CT) or a control group (no training regimen-C). It was possible to develop indirect predictive models for each training method, by including each variable pretraining, body fat percentage and body mass index. The models provided explained 82% of variance in the V[Combining Dot Above]O2max, 98% in the 1 kg ball-throw, 96% in the 3 kg ball-throw, 92% in the countermovement jump, 93% in the standing long jump and 98% in the 20 m sprint performances. This novel approach to training evaluation and control aims to provide a tool to allow professionals to calculate changes with a high confidence level (CI 95%), to control gains and to choose the best training methodology to apply according to the defined purposes. The results of this study could be a great support to teachers, coaches, and professionals providing important tools to improve the efficacy and individualization of training.

Targeted nanostructured lipid carriers for doxorubicin oral delivery

The treatment with anticancer drugs remains a challenge, as available drugs still entail the risk of deleterious off-target effects. The present study describes folic acid conjugated nanostructured lipid carriers (NLCs) as an effective doxorubicin delivery approach targeted to breast cancer cells. Two distinct NLCs formulations were designed and optimized leading to an encapsulation efficiency over than 65%. Cytotoxic and targeting potential of NLCs were studied in vitro, using MDA-MB-231 cell line. Results showed an enhanced cellular uptake of conjugated NLCs. In vitro release studies, mimicking the path in the body after oral administration, show that all formulations would reach the tumor microenvironment bearing 50% of the encapsulated doxorubicin. Moreover, NLCs demonstrated storage stability at 25 °C for at least 42 days. Overall, results revealed that the developed NLCs enable the possibility of oral administration and are a promising approach for the targeted delivery of doxorubicin to breast cancer cells.

Ultimate Full Contact: Fight Outcome Characterization Concerning Their Methods, Occurrence Times and Technical-Tactical Developments

Fight analysis produces relevant technical-tactical information. However, this knowledge is limited in hybrid full-contact combat sports. Therefore, this study aimed to characterize the results of the fights' outcomes through the winners at the World Ultimate Full Contact (WUFC) Championships between 2008 and 2017. Methods: 170 combats between senior male fighters (master class) from 38 countries were observed; all fight outcome methods, their occurrence times, inherent skills and their development forms were analyzed through frequencies, percentages, crosstabs and chi-square test, considering a Fisher's exact value of p < 0.05. The fight outcome methods were, in decreasing order, as follows: submission; decision and technical knockout (TKO); knockout (KO); and doctor stoppage. Only 19.4% fights completed the regular time 10 min (600 s), and 68.8% fight outcomes occurred in the first 5 min (300 s). Chokes were more used than joint locks, primarily developed in single actions. Head punches and kicks were the skills most responsible for KO, developed more in combinations and counter-attacks, while TKO was always through combination attacks and mostly by ground and pound. Ground fighting is most effective. In stand-up fighting, combination attacks and counter-attack are most effective. It is important to increase the technical-tactical capacities and adjustable decision-making to perform the regular fight time.

Tuberculosis among immigrants: risk factors associated with a delayed diagnosis in Portugal

Background

A timely diagnosis is a key factor to TB control, since delayed diagnosis increases transmission, severity and mortality rates. However, immigrants have a higher risk of delay due to difficulties in the access to the healthcare services. Hence, the aim of this study is to identify risk factors associated with delays in immigrants and compare the results with the national population.

Methods

We carried out a retrospective study to analyse all pulmonary TB cases notified in Portugal having a passive case finding, between 2008 and 2017. Global delay was defined as the number of days between symptoms onset and diagnosis date and divided into patient delay (time between symptoms onset and first appointment date) and healthcare services delay (time between first appointment date and diagnosis date). A descriptive analysis was performed, and factors associated with each delay were identified using a Cox regression. Analyses were stratified by country of origin: immigrants (born outside of Portugal) and nationals (Portuguese population).

Results

Our results were consistent with previous studies and showed that the immigrant population was younger, had a higher proportion of HIV infection and had a smaller proportion of alcoholics, drug addicts, inmates, homeless and individuals living in community residencies compared to nationals. Immigrants had higher patient delay (44 vs. 36 days) compared to nationals. Different risk factors were associated with the delay in immigrants and nationals. Alcohol addiction was the only significant variable in both populations and was associated with lower delay in health services.

Conclusions

Immigrants have higher global delay, attributable to a higher patient delay. The risk factors related to TB diagnosis delay have an heterogeneous association in immigrant and nationals. Hence, tailored interventions should be implemented to decrease the delay among immigrants.

Key messages

Different risk factors were identified for the patient and healthcare services delay among immigrants and nationals, which highlight the importance to analyse each component of TB diagnosis delay. Immigrants have higher patient delay compared to nationals, hence tailored interventions should be implemented to facilitate access to healthcare services in this population.

Factors related to tuberculosis delays: Evidence from nationwide retrospective study in Portugal

Background

Globally, tuberculosis (TB) remains one of the top 10 causes of deaths and the leading cause from a single infectious agent. Delayed TB diagnosis and/or treatment may result in the transmission of bacilli, increasing infectivity, the risk of severe disease states, morbidity and mortality. It is essential to identify the factors that prolong delays in TB services so that health planners can initiate necessary measures to control TB infections.

Methods

A nationwide retrospective study was conducted from 2010 until 2013 to analyze tuberculosis delays under the setting of the Portuguese National Tuberculosis Control Programme. There were 16824 participants who were from 25 administrative districts under 7 regions and were originated from 70 countries in the world. The log-rank test, Cox's regression, and the Kaplan-Meier method have employed to analyze TB delay data.

Results

The median of patients` delay was 34 days with interquartile ranges (IQR) 50 days. Alcohol addicted people with TB infection were delayed by 40 days with 95% CI 37.73-42.28 whereas the non-addicted people took 33 days with 95% CI 32.35-33.65. The median diagnostic delay was 12 days with an IQR of 38 days. The female participants were delayed more than that of male (median delay for female 17 days with 95% CI 15.80-18.19) in TB diagnosis. Further, comorbidities e.g. lung cancer affected TB candidates were delayed more than their counterparts (median delay 37 days with 95% CI 23.29-50.70). The median of public health delays was 63 days with IQR 72 days. The females were delayed more than that of males (median delay 68 days with 95% CI 66.06-69.94). The adjusted Cox's regression identifies the features - older age, female, drug addiction, and community residence as potential factors that might affect TB delays.

Conclusions

It is essential to emphasize on the influencing dynamics - older age, female patients, HIV patients, alcohol addiction, and comorbidities to minimize TB delays.

Key messages

To minimize spreading risk of TB infections the dynamics of TB delays e.g. older age, female patients, drug, and alcohol addiction, comorbidities should be prioritized in the TB control programs. Special attention should be given to other lung diseases while diagnosing TB infections.

Heat waves and mortality: developing a local prediction model based on two kinds of heat waves

Background

Heat waves (HW) will tend to have a higher impact on mortality due to climate change. The aim of this study was to develop a tailored model to predict local mortality associated to HW.

Methods

In this ecological study, daily temperature and daily mortality were collected from May to October of 1980 to 2017 in Coimbra, Portugal. Two definitions of HW were used: more than two consecutive days of maximum temperature (MaxT) or minimum temperature (MinT) above percentile 95 for the periods in question. Attributable general mortalities with 13 and 30 lag days were calculated and then converted to attributable general mortality rates adjusted to the resident population. Bivariate and multivariate analyses with SPSS statistics were performed with the following independent variables for each HW: MaxT, diurnal temperature variation (DTV), mean of the mean daily temperatures, month, ageing index (AI), ordinal number of the HW for that year (ONHW), duration, overlapping of another HW and existence of a public health contingency plan.

Results

The multivariate analyses returned a R2=0,19 for the MaxT model (MaxTM) for both 13 and 30 lag days and a R2=0,51 for the MinT model (MinTM) with 13 lag days and R2=0,45 for 30 lag days. DTV was the only variable with statistical significance in the MaxTM (p &lt; 0,023; β = 0,44 for 13 lag days and p &lt; 0,024; β = 0,43 for 30 lag days). In the MinTM model two variables had statistical significance: AI (p &lt; 0,008; β = 1,72 for 13 lag days and p &lt; 0,037; β = 0,44 for 30 lag days) and ONHW (p &lt; 0,038; β= -0,44 for 30 lag days).

Conclusions

MaxTM and MinTM had different predictability potentials with different statistical significant independent variables. This may mean HW defined by MaxT have impact in a distinct way from HW defined by MinT. Further development of these models that include acclimatization indexes and causes of mortality may help local public health services to create more efficient, selective contingency plans.

Key messages

Minimum and maximum temperature defined heat waves may impact mortality differently. Local heat wave/mortality models may contribute to more efficient, selective contingency plans than regional models.

Delays in the diagnosis of pulmonary tuberculosis in critical and non-critical areas in Portugal

Background

Delays in diagnosing tuberculosis lead to longer infectious periods, posing a challenge in tuberculosis control. This is particularly relevant in high incidence areas (critical). Thus, the objectives of this work were to characterize tuberculosis diagnosis delay and its components (patient delay and health delay) in incidence critical and non-critical areas in Portugal, as well as associated factors.

Methods

Notified cases of pulmonary tuberculosis diagnosed due to symptoms (passive screening) in the Portuguese Tuberculosis Surveillance System were analysed (2008-2017). Patient, health and overall delays were calculated. Factors associated with each delays' components were identified utilising Cox regression, while adjusting for sex, age and education level. Analyses were stratified by area type (critical and non-critical).

Results

Median (1st-3rd quartile - Q1-Q3) delays in patient, health and overall delay in critical areas were: 40 (Q1-Q3: 21-76), 8 (Q1-Q3:1-31), and 65 (Q1-Q3: 40-105) days, respectively; similar delays in non-critical areas were 32 (Q1-Q3:16-63); 9 (Q1-Q3: 1-34) and 58 (Q1-Q3: 35-98), respectively. More recent cases, adults younger than 65 years and alcoholic presented longer patient delays (both areas); healthcare professionals and patients with HIV infection presented shorter patient delays (only critical areas). Tuberculosis high-risk groups (males, alcohol dependency, homelessness, community residency) presented shorter health delays in both areas; drug use also presented shorter health delays but only in critical areas. Existing comorbidities was associated with longer health delays in both areas.

Conclusions

Patient delays increased between 2008 and 2017. Groups with longer/shorter delays differed between delay type and area type. Intervening in tuberculosis diagnosis delays requires different action for critical and non-critical areas, targeting health literacy from the general population and training of healthcare professionals.

Key messages

Delays in diagnosing in Portugal are mainly driven by delays in patient seeking care and are longer in areas of higher tuberculosis incidence. Intervening in tuberculosis diagnosis delays in Portugal requires different action in different areas, targeting health literacy in the general population and training of professionals.

Burden of disease associated with dietary exposure to carcinogenic aflatoxins in Portugal using human biomonitoring approach

Human biomonitoring is an important tool to assess human exposure to chemicals, contributing to describe trends of exposure over time and to identify population groups that could be under risk. Aflatoxins are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In Portugal, scarce data are available regarding exposure to aflatoxins and no previous study used human biomonitoring data to comprehensively characterize the associated burden of disease. 24 h urine and first-morning urine paired samples were collected by 94 participants and were analyzed by liquid chromatography-tandem mass spectrometry for the quantitative determination of aflatoxins (B₁, B₂, G₁, G₂ and M₁). Deterministic and probabilistic models were developed to assess the Portuguese exposure to aflatoxins and to estimate the health impact of this exposure, estimating the attributed Disability-Adjusted Life Years (DALYs). Aflatoxins were detected in a maximum of 13% (AFB₁), 16% (AFB₂), 1% (AFG₁), 2% (AFG₂) and 19% (AFM₁) of the urine samples. Data obtained through the probabilistic approach revealed an estimated mean probable daily intake of 13.43 ng/kg body weight per day resulting in 0.13 extra cases of hepatocellular carcinoma, corresponding to mean annual DALYs of 172.8 for the Portuguese population (10291027 inhabitants). The present study generated for the first time and within a human biomonitoring study, reliable and crucial data to characterize the burden associated to the exposure to aflatoxins of the Portuguese population. The obtained results constitute an imperative support to risk managers in the establishment of preventive policy measures that contribute to ensure public health protection.

Burden of disease attributable to exposure to aflatoxins in Portugal using Human biomonitoring data

Key messages

Portuguese population is exposed to aflatoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) to humans. Human biomonitoring studies provide realistic data on internal exposure at individual level, contributing to a more accurate estimation of the burden derived from this exposure.

Risk assessment of Portuguese population to multiple mycotoxins: the human biomonitoring approach

Key messages

Portuguese population is exposed to mycotoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) for human health. Human biomonitoring studies provide realistic data on internal exposure at individual level, allowing a more accurate knowledge of the determinants of exposure to these contaminants.

Effects of physical exercise on outcomes of cardiac (dys)function in women with breast cancer undergoing anthracycline or trastuzumab treatment: study protocol for a systematic review

BACKGROUND

Cardiotoxicity is a known complication and one of the most adverse effects from the use of conventional treatments such as anthracyclines and trastuzumab in breast cancer (BC) care. This phenomenon has been associated with the restriction of therapeutic options and the increase of cardiovascular complications, which may compromise the survival of patients. Implementation of preventive strategies is an important approach for the management of this issue. Physical exercise has been proposed as a non-pharmacological strategy to counteracting cardiotoxicity. The aim of this protocol is to describe the rationale and methods for a systematic review of published randomized controlled trials (RCTs) that have analysed the effects of physical exercise on outcomes of cardiac (dys)function in women with BC undergoing neoadjuvant or adjuvant treatment containing anthracyclines and/or trastuzumab.

METHODS AND ANALYSIS

This is a protocol for a systematic review reported according to the PRISMA-P 2015 checklist. Randomized controlled trials (RCTs) will be included. The literature will be screened on MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus. The risk of bias of the included RCTs will be assessed using the Cochrane Collaboration's tool. The primary outcomes will be systolic function (left ventricular ejection fraction), diastolic function (E/A' ratio, deceleration time of early left ventricular filling, isovolumetric relaxation time, E/E' septal and lateral ratio) and myocardial deformation imaging outcomes (strain and strain rate [measured in longitudinal, radial, or circumferential directions]). Secondary outcomes will be cardiac biomarkers (troponin I or T, high-sensitivity troponin I or T, brain natriuretic peptide, amino terminal of B-type natriuretic peptide). Data will be descriptively reported, and quantitative synthesis will also be considered if the included studies are sufficiently homogenous.

DISCUSSION

This systematic review will help to understand the effectiveness of physical exercise on counteracting cardiotoxicity related to anticancer therapies in women with BC.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018096060.

Multidrug-resistant tuberculosis in Lisbon: unfavourable treatment and associated factors, 2000-2014

SETTING: The incidence of tuberculosis (TB) has been decreasing in Portugal. Lisbon concentrates the largest number of cases of multidrug-resistant (MDR) TB in the country. This study aims at identifying clinical and demographic factors associated with unfavourable treatment results of patients with MDR-TB in the city.METHOD: The data on 265 MDR-TB cases, notified from 2000 to 2014 in the District of Lisbon, were collected from the Tuberculosis Surveillance System. Unfavourable cases were classified as failure, loss to follow-up (LTFU) and death. Bivariate and multivariate logistic regressions were undertaken to estimate the factors associated with unfavourable outcomes, LTFU and death.RESULTS: The proportion of unfavourable outcomes was 30.5%. These were associated mostly with being male, foreign-born and resistant to kanamycin. Death was associated with being human immunodeficiency virus-positive and resistant to kanamycin. Being foreign-born had a 4.46-fold higher odds of a LTFU outcome than did being Portuguese-born. The foreign-born patients were mostly African immigrants.CONCLUSION: The main finding in this study is that foreign-born patients are associated with a higher probability of unfavourable outcomes than Portuguese-born patients. Therefore, foreign-born patients need more careful monitoring in the control of MDR-TB.

Impact of exercise training on cardiotoxicity and cardiac health outcomes in women with breast cancer anthracycline chemotherapy: a study protocol for a randomized controlled trial

BACKGROUND

Anthracyclines are chemotherapeutic agents frequently used in breast cancer (BC) treatment. Although it improves disease-free and overall survival, the use of anthracyclines is associated with a cumulative risk of cardiac toxicity. Preventive strategies to optimize cardiac health are needed and exercise is proposed as a potential non-pharmacological approach for counteracting anthracycline-related cardiotoxicity (ARC). Most of the data on the effects of exercise to reduce ACT are from animal studies, with only a few studies in a limited number of patients indicating beneficial effects. To better understand the effectiveness of exercise in the mitigation of ARC, clinical, real-world trials claim require a larger sample size and more accurate and valuable clinical biomarkers. In this study, we intend to include a large sample and investigate cardiac function through serial measures of biomarkers and imaging techniques.

METHODS

This protocol describes a two-arm, prospective, randomized controlled trial that will explore the cardioprotective effect of a structured exercise program in women with BC undergoing anthracycline-containing chemotherapy (ACT). Ninety adult women with early BC and recommended to receive ACT will be randomly assigned (1:1) to an intervention group or a control group. Patients allocated to the intervention group will perform a supervised exercise program three times per week, consisting of a combination of aerobic and resistance training with progressive intensity and volume, during the time period they receive ACT. The control group will receive standard BC care. Primary outcomes related to cardiac (dys)function will be circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, resting left ventricular (LV) longitudinal strain, and resting LV ejection fraction. Secondary outcomes will include the assessment of resting blood pressure, resting heart rate (HR), resting HR variability (HRV), recovery HR, physical function outcomes, self-reported physical activity level, health-related quality of life, and fatigue. Data will be obtained at baseline (t₀), after the end of anthracycline-treatment (t₂), and 3 months after t2 (t₃). Additionally, NT-proBNP will be measured 1-24 h prior to each anthracycline-treatment cycle (t1).

DISCUSSION

The implementation of the present study design, using novel clinical biomarkers, will determine the effect of structured exercise interventions at mitigating ARC, with the overall aim of finding means to further improve BC care.

TRIAL REGISTRATION

ISRCTN, ISRCTN32617901 . Registered on 24 October 2018. Last updated on 11 January 2019.